|Figure 1: Papular purpuric lesions presented exclusively on the hands with a sharp demarcation at the wrists|
In March 2004 a 19-year-old man was seen in our department for a 6-day history of papular purpuric lesions located exclusively on the hands (Fig. 1) and feet with a sharp demarcation at the wrists and the ankles. Edema, itching, and pain were also present. The eruption was preceded by fever, abdominal pain, anorexia, and asthenia. Neither oral lesions nor lymphadenopathy were present. Laboratory studies were within normal limits with the exception of a mildly elevated white blood cell count, erythrocyte sedimentation rate at 22 mm/h, and protein C reactive at 2 mg/dl.
Serologic markers for Epstein Barr virus, parvovirus, measles virus, cytomegalovirus, hepatitis B and C virus, Rickettsia, HIV, herpes simplex virus 1 and 2 were tested with an indirect enzyme linked immunosorbent assay on the sixth day and on the eleventh day after onset of the clinical eruption. The results were within normal limits with the exception of assays for parvovirus B19 IgG and IgM confirming acute infection in the second week. The diagnosis of acute parvovirus B19 infection was made on the basis of the presence of specific IgM antibodies in serum samples assayed at two different times during the patient's illness. Based on the clinical picture and the laboratory data the diagnosis of PPGSS was made. The eruption cleared after palmoplantar desquamation in 12 days.