Abstract

Herein we report two cases of papular purpuric gloves and socks syndrome (PPGSS) which showed subtle vascular damage, mimicking early leukocytoclastic vasculitis. PPGSS is a self‐limited dermatosis characterized by pruritic erythematous petechiae and papules in a “gloves and socks” distribution. It is associated with parvovirus‐B19 or other viral infections. Histopathologically, early lesions often show nonspecific changes including perivascular lymphocytic infiltrate with extravasated erythrocytes, papillary dermal edema, spongiosis, and acanthosis. The diagnosis relies on clinicopathologic correlation, direct immunofluorescence (DIF) and viral serology studies.

We encountered two PPGSS cases. The first patient was a 42-year-old female with a recently sick child who presented with polyarthralgias and purpuric macules/patches on upper and lower extremities. The second patient was a 46-year-old female who developed purpuric macules and patches on lower extremities and edema on hands.

The biopsies from both patients demonstrated a mild perivascular lymphocytic infiltrate with some neutrophils, extravasated erythrocytes, and focal fibrinoid necrosis in rare superficial capillaries. No leukocytoclasia is seen. DIF was negative for one case and showed weak C3 and fibrinogen in rare vessels for the other. Both patients had parvovirus B19 antibodies with IgM and IgG for one patient and IgM for the other. Based on the clinical presentation and serology, a diagnosis of PPGSS was favored.

Our cases demonstrated that focal subtle vascular damage may be seen in PPGSS. We emphasize the importance of performing parvovirus B19 serology studies and correlating with clinical information to facilitate the diagnosis.