Journal Article

Atypical hand, foot, and mouth disease: a vesiculobullous eruption caused by Coxsackie virus A6

Bennett, Nicholas, Feder, Henry M, Modlin, John F

2014

Overview

A previously well infant aged 9 months presented with an acute, self-limiting illness characterised by high fever and a papular eruption that started on the face. Although fever subsided within 3 days, the rash worsened and extended over the whole body, with some papules evolving into vesiculobullous lesions. The infant had been exposed to children with a similar illness 1 week before onset. PCR of vesicular swabs and stool samples taken on day 6 of illness showed Coxsackie virus A6. The illness resolved within 10 days of onset, although onychomadesis was seen on both big toes at follow-up 5 weeks later. Our case exemplifies the severe, atypical cases of hand, foot, and mouth disease that have been reported worldwide since 2008, and in the USA since the 2011. Atypical hand, foot, and mouth disease is caused by a new lineage of Coxsackie virus A6 and is characterised by high fever and vesiculobullous eruptions on the calves and backs of the hands. Infants with eczema might be predisposed to severe disease.

• Publisher: Elsevier Ltd,Lancet Publishing Group,Elsevier Limited
• Subject: Biological and medical sciences / Children / Coxsackievirus / Enterovirus - classification / Enterovirus - isolation & purification / Feces - virology / Hand, Foot and Mouth Disease - diagnosis / Hand, Foot and Mouth Disease - pathology / Hand, Foot and Mouth Disease - virology / Human viral diseases / Humans / Infant / Infants / Infectious Disease / Infectious diseases / Male / Medical sciences / Polymerase Chain Reaction / Skin - pathology / Skin - virology / Skin diseases / Skin Diseases, Vesiculobullous - etiology / Skin Diseases, Vesiculobullous - pathology / Skin Diseases, Vesiculobullous - virology / United States / Viral diseases / Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye