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

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

Features that differ from classic hand, foot and mouth disease include 'a high rate of onychomadesis (shedding of the nail) during convalescence due to arrest of nail-matrix growth'.

Main

Feder Jr HM, Bennett N, Modlin JF. Lancet Infect Dis 2014; 14: 83–86

This case report describes a 9-month-old boy who presented with a one-day history of fever (rectal temperature of 39·4 °C) and papular exanthema which first appeared around the mouth and then extended to the face, trunk and buttocks. There was an ulcer on the buccal mucosa. Coxsackie virus A6 was found in the stools and a vesicular-fluid sample. The differential diagnosis included 1) varicella zoster virus infection, 2) eczema herpeticum, and 3) bullous impetigo. Although enterovirus infections are not notifiable in the USA, recently 63 other cases of severe, atypical hand, foot, and mouth disease, in four states, were reported. All were caused by Coxsackie virus A6 and in 63% of this group, the patients were younger than years old. Nineteen percent were admitted to hospital which is a higher rate compared with typical hand, foot, and mouth disease.