gianotti  crosti syndrome ( gcs ) is a self - limiting dermatosis of unknown etiology affecting children . it is characterized by papular eruption with a symmetrical distribution over the limbs and face . gcs was initially believed to be associated exclusively with hepatitis b infection but later other viruses such as epstein barr virus , hepatitis a , cytomegalovirus , coxsackie , adenovirus , enterovirus , rotavirus , rubella , parainfluenza , hiv , human herpes virus 6 , echovirus , parvovirus , mumps , molluscum contagiosum , and respiratory syncytial virus have been implicated as well . even bacterial infections due to borrelia burgdorferi , bartonella henselae , -hemolytic streptococci , and mycoplasma pneumoniae , as well as preceding immunization have been found to be associated with gcs . we report a case of gcs in an 18-month - old child associated with diptheria , pertussis , and tetanus ( dpt ) and oral polio vaccine ( opv ) booster vaccination . to our knowledge an 18-month - old developmentally normal boy presented with generalized itching and symmetrical skin lesions predominantly on the extensor aspect of all four extremities for one week duration . these lesions developed three days following dpt ( diptheria pertussis tetanus vaccine ( adsorbed ) ip , pasteur institute of india , kunnoor , tamil nadu , india ) and opv ( oral polio vaccine , bharath immunologicals and biologicals , chola , bulandshahr , u.p , india ) booster immunization given at one - and - half years as per the national immunization schedule . child started having fever and rashes , while fever subsided after 3 days , rash persisted . lesions started over both upper limbs and progressed to involve the buttocks , lower limbs , and face . on examination , the child had multiple , small , skin - colored papules involving his face , buttocks , upper and lower limbs with minimal involvement of the trunk [ figures 1 and 2 ] . the lymph nodes were small ( < 1 cm ) , nontender , firm , and mobile . blood counts , biochemical profile , and serology for hepatitis b , c , and epstein  barr virus were within normal limits . a diagnosis of gianotti  crosti syndrome ( papular acrodermatitis of childhood ) was considered based on the characteristic morphology of the lesions . ( a ) symmetrically distributed papules on the forehead and cheeks ( b ) papules on the extensor aspect of upper limb ( a ) erythematous papules present on the extensor aspect of lower extremities and the gluteal region ( b ) gcs was initially described by gianotti and crosti in 1955 who named it as  papular acrodermatitis of childhood . it is a dermatosis characterized by skin - colored to erythematous flat - topped papules measuring 25 mm in diameter , distributed symmetrically on the face , buttocks , and extremities . apart from viral infections , gcs is also associated with vaccinations . numerous reports of gcs occurring in relation to vaccination have been documented [ table 1 ] . vaccines reported to cause gcs include mmr , oral polio vaccine , influenza , japanese encephaltitis , hepatitis a , and dpt vaccines . gcs might be a self - limiting dermatological response to viruses and the variation in the morphology may be due to individual characteristics of patients rather than the virus itself . it has been observed that  combination  and  live  vaccines increase the risk of gcs . the risk is also increased when vaccines are administered in the presence of viral infection . characteristics of vaccine - associated gcs cases reported in literature high t - cell reactivity due to preceding infection or preceding vaccination might be the underlying cause of gcs . the present case strengthens the hypothesis that immunization during or followed by a viral infection can possibly result in gianotti  crosti syndrome . we report a case of vaccine - induced gcs in an 18-month - old child . healthcare practitioners should be aware of this rare , self - limiting dermatological complication associated with vaccination . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s ) has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s ) has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .
gianotti  crosti syndrome ( gcs ) is an uncommon dermatological condition characterized by distinct , self - limiting , symmetrical , erythematous , papulovesicular eruptions distributed mainly on the extremities , buttocks and face in young children . although gcs is commonly attributed to viral infections , vaccinations too can rarely precipitate this condition . 
 we report a rare case of gcs following diptheria , pertussis , and tetanus ( dpt ) and oral polio immunisation in an 18-month - old child along with a review of similar vaccine - induced gcs cases reported in the literature .