Graham Little-Piccardi-Lasseur syndrome following HBV vaccination.

A 48-year-old man, who was at risk for HBV infection as he worked as a nurse in an emergency department, received HBV vaccine Recombivax (Merck-Sharp & Dohme, MSD). The ¢rst dose of vaccine (1 ml) was given to the patient in July 1995 and the second (1ml) 4 weeks later. At the end of September 1995 the patient noted an eruption of numerous, polygonal, red and itchy papules localized on the trunk, limbs and wrists. No mucosal involvement was present. All routine laboratory tests results were normal, HBsAg and HBeAg results were negative while HBsAb and HBcAb were positive. The patient therefore consulted his general practitioner who diagnosed this condition as drug eruption and for which he prescribed antihistamines per os for 1 month. The condition healed in 6 weeks leaving a hyperpigmentation. Six months after the ¢rst dose the patient received the third vaccine dose (1 ml); 5 months later spinous, acuminate, follicular papules a¡ecting the scalp occurred. In November 1996 he consulted us. The dermatological examination revealed hyperpigmented polygonal, £at papules localized on the wrists and ankles and brown spots on the lateral surface of the trunk, probably the result of previous episodes of LRP. On the scalp some cicatricial alopecic areas as well as di¡use alopecia with ¢ne and coarse hair were present. The diagnosis of GLPLS was therefore formulated and con¢rmed on histological examination. The patient was treated with systemic and topical corticosteroids for 4 months, leading to healing of the hyperkeratotic papules, the alopecia still persisting.