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Granuloma Annulare-like Eruption due to Chronic Epstein-Barr Virus Infection

Granuloma Annulare-like Eruption due to Chronic Epstein-Barr Virus Infection Abstract • A 32-year-old woman afflicted with a severe, chronic Epstein-Barr virus (CEBV) infection of 12 months' duration developed an unusual, granuloma annulare-like eruption. The cutaneous disorder, which paralleled the clinical course of her disease, was characterized by slightly raised, erythematous, annular lesions predominantly involving the face and arms, with sporadic involvement elsewhere. Histopathologic examination of biopsy material obtained from affected skin disclosed a granulomatous dermatitis. The patient's symptoms and cutaneous eruption resolved after systemic corticosteroid therapy. This eruption may represent a distinct cutaneous component of CEBV infection with clinically granuloma annulare-like features or the mere serendipitous association of CEBV infection and an unusual granulomatous dermatitis. Because of the unusual clinical appearance of the eruption and its clear correlation with disease activity, we speculate that it likely represents a distinct cutaneous condition, heretofore unreported, caused by CEBV infection. (Arch Dermatol 1988;124:250-255) References 1. Straus SE, Tosato G, Armstrong G, et al: Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection . Ann Intern Med 1985;102:7-16.Crossref 2. Jones JF, Ray G, Minnich LL, et al: Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: Elevated anti-early antigen antibodies . Ann Intern Med 1985;102:1-7.Crossref 3. Tobi M, Morag A, Ravid Z, et al: Prolonged atypical illness associated with serological evidence of persistent Epstein-Barr virus infection . Lancet 1982;1:61-63.Crossref 4. Buchwald D, Sullivan JL, Komaroff AL: Frequency of chronic active Epstein-Barr virus infection in a general medical practice . JAMA 1987;257:2303-2307.Crossref 5. Coskey RJ, Paul L: Ampicillin sensitivity in infectious mononucleosis . Arch Dermatol 1969;100:717-719.Crossref 6. Pullen H, Wright N, Murdoch JM: Hypersensitivity reactions to antibacterial drugs in infectious mononucleosis . Lancet 1967; 2:1176-1178.Crossref 7. Naparstek Y, Levy M: Rash and infectious mononucleosis . Ann Intern Med 1982;97:284.Crossref 8. McCarthy JT, Hoagland RJ: Cutaneous manifestations of infectious mononucleosis . JAMA 1964;187:153-154. 9. Bonnetblanc JM, Gualde N, Gaillard J, et al: Urticaire au froid révélatrice d'une mononucléose infectieuse . Presse Med 1983; 12:1174. 10. Caird FI, Holt PR: The enanthem of glandular fever . Br Med J 1958;1:85-87.Crossref 11. Eng AM: Erythematous generalized granuloma annulare . Arch Dermatol 1979;115:1210-1211.Crossref 12. Burnett JW, Wood C, Sina B, et al: Inflammatory granuloma annulare . Cutis 1986;37:267-268. 13. Henle W, Henle GE, Horwitz CA: Epstein-Barr virus specific diagnostic tests in infectious mononucleosis . Hum Pathol 1974; 5:551-565.Crossref 14. Lamy ME, Favart AM, Cornu C, et al: Study of Epstein Barr virus (EBV) antibodies: IgG and IgM anti-VCA, IgG anti-EA and Ig anti-EBNA obtained with an original microtiter technique: Serological criterions of primary and recurrent EBV infections and follow-up of infectious mononucleosis: Seroepidemiology of EBV in Belgium based on 5178 sera from patients . Acta Clin Belg 1982;37:281-298. 15. Merlin TL: Chronic mononucleosis: Pitfalls in the laboratory diagnosis . Hum Pathol 1986;17:2-8.Crossref 16. Henle G, Henle W, Horwitz CA: Antibodies to Epstein-Barr virus-associated nuclear antigen in infectious mononucleosis . J Infect Dis 1974;130:231-239.Crossref 17. Henle W, Henle G: Epstein-Barr virus-specific serology in immunologically compromised individuals . Cancer Res 1981; 41:4222-4225. 18. Hendry BM, Longmore JM: Systemic lupus erythematosus presenting as infectious mononucleosis with a false-positive Monospot test . Lancet 1982;1:455.Crossref 19. Young GAR, Vincent PC: Infectious mononucleosis and systemic lupus erythematosus . Lancet 1982;1:971.Crossref 20. Stancek D, Rovensky J: Enhancement of Epstein-Barr virus antibody production in systemic lupus erythematosus patients . Acta Virol 1979;23:168-169. 21. Tan EM, Cohen AS, Fries JF, et al: The 1982 revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum 1982;25:1271-1277.Crossref 22. Hanke CW, Bailin PL, Roenigk HH Jr: Annular elastolytic giant cell granuloma: A clinicopathologic study of five cases and a review of similar entities . J Am Acad Dermatol 1979;5:413-421.Crossref 23. Dowling GB, Jones EW: Atypical (annular) necrobiosis lipoidica of the face and scalp . Dermatologica 1967;135:11-26.Crossref 24. Mehregan AH, Altman J: Miescher's granuloma of the face: A variant of the necrobiosis lipoidica-granuloma annulare spectrum . Arch Dermatol 1973;107:62-64.Crossref 25. O'Brien JP: Actinic granuloma . Arch Dermatol 1975;111:460-466.Crossref 26. Muhlbauer JE: Granuloma annulare . J Am Acad Dermatol 1980;3:217-230.Crossref 27. Dahl MV, Ullman S, Goltz RW: Vasculitis in granuloma annulare . Arch Dermatol 1977;113:463-467.Crossref 28. Labbe A, Peyrot J: Gianotti-Crosti syndrome and Epstein-Barr virus infection . J Pediatr 1983;102:1013-1014.Crossref 29. Iosub S, Santos C, Gromisch DS: Papular acrodermatitis with Epstein-Barr virus infection . Clin Pediatr 1984;23:33-34.Crossref 30. Llorens-Terol J, Martinez-Roig A: Erythema nodosum associated with infectious mononucleosis . Helv Paediatr Acta 1983; 38:91-94. 31. Barth JH: Infectious mononucleosis (glandular fever) complicated by cold agglutinins, cold urticaria and leg ulceration . Acta Derm Venereol 1981;61:451-452. 32. Copperman SM: Infectious mononucleosis and leukemia . JAMA 1982;247:1808.Crossref 33. Urman JD, Bobrove AM: Acute polyarthritis and infectious mononucleosis . West J Med 1982;136:151-153. 34. McMahon JM: Case discussion related to the report by Sigal et al . Arthritis Rheum 1984;27:240.Crossref 35. Aho K, Raunio V: EB-virus and rheumatoid arthritis: New insights into their interrelation . Med Biol 1982;60:49-52. 36. Petrozzi JW: Infectious mononucleosis manifesting as a palmar dermatitis . Arch Dermatol 1971;104:207-209.Crossref 37. Joncas J, LaPointe N, Gervais F, et al: Unusual prevalence of antibodies to Epstein-Barr virus early antigen in ataxia telangiectasia . Lancet 1977;1:1160.Crossref 38. Brandfonbrener A, Epstein A, Wu S, et al: Corticosteroid therapy in Epstein-Barr virus infection . Arch Intern Med 1986;146:337-339.Crossref 39. Schooley RT, Carey RW, Miller G, et al: Chronic Epstein-Barr virus infection associated with fever and interstitial pneumonitis . Ann Intern Med 1986;104:636-643.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Granuloma Annulare-like Eruption due to Chronic Epstein-Barr Virus Infection

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References (45)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1988.01670020068020
Publisher site
See Article on Publisher Site

Abstract

Abstract • A 32-year-old woman afflicted with a severe, chronic Epstein-Barr virus (CEBV) infection of 12 months' duration developed an unusual, granuloma annulare-like eruption. The cutaneous disorder, which paralleled the clinical course of her disease, was characterized by slightly raised, erythematous, annular lesions predominantly involving the face and arms, with sporadic involvement elsewhere. Histopathologic examination of biopsy material obtained from affected skin disclosed a granulomatous dermatitis. The patient's symptoms and cutaneous eruption resolved after systemic corticosteroid therapy. This eruption may represent a distinct cutaneous component of CEBV infection with clinically granuloma annulare-like features or the mere serendipitous association of CEBV infection and an unusual granulomatous dermatitis. Because of the unusual clinical appearance of the eruption and its clear correlation with disease activity, we speculate that it likely represents a distinct cutaneous condition, heretofore unreported, caused by CEBV infection. (Arch Dermatol 1988;124:250-255) References 1. Straus SE, Tosato G, Armstrong G, et al: Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection . Ann Intern Med 1985;102:7-16.Crossref 2. Jones JF, Ray G, Minnich LL, et al: Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: Elevated anti-early antigen antibodies . Ann Intern Med 1985;102:1-7.Crossref 3. Tobi M, Morag A, Ravid Z, et al: Prolonged atypical illness associated with serological evidence of persistent Epstein-Barr virus infection . Lancet 1982;1:61-63.Crossref 4. Buchwald D, Sullivan JL, Komaroff AL: Frequency of chronic active Epstein-Barr virus infection in a general medical practice . JAMA 1987;257:2303-2307.Crossref 5. Coskey RJ, Paul L: Ampicillin sensitivity in infectious mononucleosis . Arch Dermatol 1969;100:717-719.Crossref 6. Pullen H, Wright N, Murdoch JM: Hypersensitivity reactions to antibacterial drugs in infectious mononucleosis . Lancet 1967; 2:1176-1178.Crossref 7. Naparstek Y, Levy M: Rash and infectious mononucleosis . Ann Intern Med 1982;97:284.Crossref 8. McCarthy JT, Hoagland RJ: Cutaneous manifestations of infectious mononucleosis . JAMA 1964;187:153-154. 9. Bonnetblanc JM, Gualde N, Gaillard J, et al: Urticaire au froid révélatrice d'une mononucléose infectieuse . Presse Med 1983; 12:1174. 10. Caird FI, Holt PR: The enanthem of glandular fever . Br Med J 1958;1:85-87.Crossref 11. Eng AM: Erythematous generalized granuloma annulare . Arch Dermatol 1979;115:1210-1211.Crossref 12. Burnett JW, Wood C, Sina B, et al: Inflammatory granuloma annulare . Cutis 1986;37:267-268. 13. Henle W, Henle GE, Horwitz CA: Epstein-Barr virus specific diagnostic tests in infectious mononucleosis . Hum Pathol 1974; 5:551-565.Crossref 14. Lamy ME, Favart AM, Cornu C, et al: Study of Epstein Barr virus (EBV) antibodies: IgG and IgM anti-VCA, IgG anti-EA and Ig anti-EBNA obtained with an original microtiter technique: Serological criterions of primary and recurrent EBV infections and follow-up of infectious mononucleosis: Seroepidemiology of EBV in Belgium based on 5178 sera from patients . Acta Clin Belg 1982;37:281-298. 15. Merlin TL: Chronic mononucleosis: Pitfalls in the laboratory diagnosis . Hum Pathol 1986;17:2-8.Crossref 16. Henle G, Henle W, Horwitz CA: Antibodies to Epstein-Barr virus-associated nuclear antigen in infectious mononucleosis . J Infect Dis 1974;130:231-239.Crossref 17. Henle W, Henle G: Epstein-Barr virus-specific serology in immunologically compromised individuals . Cancer Res 1981; 41:4222-4225. 18. Hendry BM, Longmore JM: Systemic lupus erythematosus presenting as infectious mononucleosis with a false-positive Monospot test . Lancet 1982;1:455.Crossref 19. Young GAR, Vincent PC: Infectious mononucleosis and systemic lupus erythematosus . Lancet 1982;1:971.Crossref 20. Stancek D, Rovensky J: Enhancement of Epstein-Barr virus antibody production in systemic lupus erythematosus patients . Acta Virol 1979;23:168-169. 21. Tan EM, Cohen AS, Fries JF, et al: The 1982 revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum 1982;25:1271-1277.Crossref 22. Hanke CW, Bailin PL, Roenigk HH Jr: Annular elastolytic giant cell granuloma: A clinicopathologic study of five cases and a review of similar entities . J Am Acad Dermatol 1979;5:413-421.Crossref 23. Dowling GB, Jones EW: Atypical (annular) necrobiosis lipoidica of the face and scalp . Dermatologica 1967;135:11-26.Crossref 24. Mehregan AH, Altman J: Miescher's granuloma of the face: A variant of the necrobiosis lipoidica-granuloma annulare spectrum . Arch Dermatol 1973;107:62-64.Crossref 25. O'Brien JP: Actinic granuloma . Arch Dermatol 1975;111:460-466.Crossref 26. Muhlbauer JE: Granuloma annulare . J Am Acad Dermatol 1980;3:217-230.Crossref 27. Dahl MV, Ullman S, Goltz RW: Vasculitis in granuloma annulare . Arch Dermatol 1977;113:463-467.Crossref 28. Labbe A, Peyrot J: Gianotti-Crosti syndrome and Epstein-Barr virus infection . J Pediatr 1983;102:1013-1014.Crossref 29. Iosub S, Santos C, Gromisch DS: Papular acrodermatitis with Epstein-Barr virus infection . Clin Pediatr 1984;23:33-34.Crossref 30. Llorens-Terol J, Martinez-Roig A: Erythema nodosum associated with infectious mononucleosis . Helv Paediatr Acta 1983; 38:91-94. 31. Barth JH: Infectious mononucleosis (glandular fever) complicated by cold agglutinins, cold urticaria and leg ulceration . Acta Derm Venereol 1981;61:451-452. 32. Copperman SM: Infectious mononucleosis and leukemia . JAMA 1982;247:1808.Crossref 33. Urman JD, Bobrove AM: Acute polyarthritis and infectious mononucleosis . West J Med 1982;136:151-153. 34. McMahon JM: Case discussion related to the report by Sigal et al . Arthritis Rheum 1984;27:240.Crossref 35. Aho K, Raunio V: EB-virus and rheumatoid arthritis: New insights into their interrelation . Med Biol 1982;60:49-52. 36. Petrozzi JW: Infectious mononucleosis manifesting as a palmar dermatitis . Arch Dermatol 1971;104:207-209.Crossref 37. Joncas J, LaPointe N, Gervais F, et al: Unusual prevalence of antibodies to Epstein-Barr virus early antigen in ataxia telangiectasia . Lancet 1977;1:1160.Crossref 38. Brandfonbrener A, Epstein A, Wu S, et al: Corticosteroid therapy in Epstein-Barr virus infection . Arch Intern Med 1986;146:337-339.Crossref 39. Schooley RT, Carey RW, Miller G, et al: Chronic Epstein-Barr virus infection associated with fever and interstitial pneumonitis . Ann Intern Med 1986;104:636-643.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Feb 1, 1988

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