DIFFERENTIAL DIAGNOSIS, INVESTIGATIONS AND TREATMENT
A combined systemic therapy with amoxicillin-clavulanate and betamethasone was recommended, with a progressive improvement of skin lesions.
Meanwhile, further investigations were performed to exclude an autoimmune bollous disease.
Antibody serology tests for CMV, EBV, Parvovirus and Mycoplasma pneumoniae were obtained and a biopsy with perilesional direct immunofluorescence was performed.
Positive results of anti-VCA-EBV IgM, anti-VCA-EBV IgG, anti-EBNA-IgG and EBV-DNA tests was obtained, denoting an acute EBV infection.
Histologic examination showed hyperkeratosis, acanthosis and spongiosis of the epidermis, while, in a markedly edematous papillary dermis, a lymphocytic and neutrophilic granulocytic infiltrate was observed. A monomorphic perivascular lymphocytic infiltrate was present deeper in the dermis. Histopathological findings supported the hypothesis of a paraviral rash (Fig3).
The presence of small deposits of C3 in the absence of IgG, IgA or IgM at the dermo-epidermal junction allowed us to exclude autoimmune bullous disease. The patient underwent close dermatological follow-up during the course of EBV infection, observing a progressive resolution of skin lesions and no clinical relapses.