Annular Eruptive Pseudoangiomatosis and Adenovirus Infection: A Novel Clinical Variant of Paraviral Exanthems and a Novel Virus Association

Abstract

Eruptive pseudoangiomatosis is a distinct exanthem thought to be caused by viruses. The usual rash configu-ration is erythematous papules and macules. An association with echovirus infection has been reported. We present here one adult and one child with this exanthem, supported by clinical, histopathological, and immunohistochemical findings. Both patients presented with prodromal symptoms, widespread angioma-like macules in annular configuration, blanchable telangiectasia, followed by spontaneous remission in 6-8 weeks. Lesional histopathology of the adult patient revealed dilated dermal blood vessels and lymphohistiocytic infiltrates predominated by CD4+ lymphocytes with a 5:1 ratio of CD4:CD8 lymphocytes. No B cells or CD56+ natural killer cells were found. Serology of both patients revealed evidence of active infections by adenoviruses, and a range of other viruses were excluded. We believe that these 2 patients manifested annular eruptive pseudoangio-matosis, a novel variant of the rash with a probable adenovirus association that has not yet been reported.

Eruptive pseudoangiomatosis in two children with acute lymphoblastic leukemia

“…However, no single microorganism‐disease etiology has been established. Since EPA has been associated with several viral infections, it could represent a peculiar host response to different viruses . None of our patients had prodromal symptoms that suggested a previous viral infection, however antibody titers to selected viruses were only tested in the second patient and were negative.…”

Infectious exanthemas in childhood

“…Enteroviruses 25 and 32 have been reported as being associated with eruptive pseudoangiomatosis [2,43]. This paraviral exanthema may also be associated with adenoviruses [44,45].…”

Infektiöse Exantheme im Kindesalter

“…Enterovirus 25 und 32 wurden mit eruptiver Pseudoangiomatose assoziiert beschrieben [2,43]. Zu den assoziierten Viren dieses paraviralen Exanthems zählen auch Adenoviren [45].…”