FLEXURAL PURPURA AND EPSTEIN-BARR-VIRUS INFECTION

A 38-year-old woman presented with flexural lesions of 4 days duration , accompanied by pruritus in her hands, arthralgia, sore throat, and a 38 degrees C fever. Examination revealed macular purpuric lesions wit h a tendency to be grouped into plaques that affected, in a selective way, the axillary folds (Fig. 1), the elbow flexures, and the inguinal (Fig. 2) and perianal areas. Inflammatory laterocervical and submandi bular lymphadenopathy was noted. Histopathologic examination showed a normal epidermis and a perivascular lymphocytic infiltrate in the papi llar dermis, consisting of eosinophils and extravasated red cells. Vas culitis and other signs of vascular damage were not observed. A Congo red stain was negative. Laboratory tests showed moderate lymphocytosis with 2% atypical lymphocytes and mild elevation of serum glutamic-oxa loacetic transaminase (SGOT) and serum glutamic pyruvic transaminase ( SGPT). Coagulation studies, urinalysis, immunoglobulins, and serum ele ctrophoresis were normal. Cryoglobulins were negative. Serology for cy tomegalovirus (CMV), toxoplasma, rubella, and human parvovirus B19 sho wed findings of past infection. Serology for A, B and C hepatitis viru s was negative. Mono-spot test was negative and the Epstein-Barr virus (EBV specific antibody response is shown in Table 1. The standard Tru e-test was negative. The clinical manifestation cleared spontaneously within 15 days.