Abstract
GIANOTTI disease (GD) is considered a clinical expression of hepatitis B virus (HBV) infection in infants and children. 1 The principal features of the disease include an erythematous papular exanthem distributed mainly on the face and extremities, an anicteric hepatitis, and HBV surface antigenemia. 2,3 The pathogenesis of these distinctive clinical manifestations is unclear but appears to be an age-dependent response to HBV infection. During an epidemic in Matsuyama, Japan, parents who contracted HBV infection from children with GD had development of acute hepatitis with jaundice; most did not have the characteristic rash present in the index patients. 1 In spite of the worldwide distribution of GD, 4 we are aware of only four reported cases among children in the United States. 5-7 Furthermore, two of these cases had negative test results for hepatitis B surface antigen (HBsAg) 6 ; one other patient was not tested for it. 7 We describe
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