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.