Atypical Gianotti-Crosti syndrome associated with Epstein-Barr virus in a 3-month-old infant: a case report and systematic literature review.

Abstract

Gianotti-Crosti syndrome (GCS) is a self-limiting infantile exanthem that typically presents with monomorphic acral papules. We report a case of primary Epstein-Barr virus (EBV)-associated GCS in a 3-month-old infant featuring an extensive vesiculobullous eruption with trunk involvement. To characterize the clinical spectrum reported in the literature, PubMed, Scopus, Web of Science, and the Cochrane Library were searched from January 1983 to March 2026 in accordance with PRISMA 2020 guidelines. Including the present patient, 45 laboratory-confirmed cases from 25 sources were analyzed. Among 42 patients with available age data, four were under one year of age. Vesiculobullous morphology occurred in only two cases, whereas trunk involvement was reported in approximately 35% of cases. Lymphadenopathy and elevated liver enzymes were identified in 52% and 56% of cases, respectively. EBV-associated GCS can thus present in early infancy and extend beyond its classic morphology and distribution. Recognition of these atypical variants may prevent unnecessary diagnostic workups and support conservative management.