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Case Report/Case Series |

Coxsackievirus A6–Induced Hand-Foot-Mouth Disease

Campbell L. Stewart, MD1; Emily Y. Chu, MD, PhD1; Camille E. Introcaso, MD2; Andras Schaffer, MD, PhD1; William D. James, MD1
[+] Author Affiliations
1Department of Dermatology, University of Pennsylvania, School of Medicine, Philadelphia
2Pennsylvania Centre for Dermatology, Pennsylvania Hospital, Philadelphia
JAMA Dermatol. 2013;149(12):1419-1421. doi:10.1001/jamadermatol.2013.6777.
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Importance  Hand-foot-mouth disease (HFMD) is an acute, self-limited, highly contagious viral illness that commonly affects children younger than 5 years. It is most typically caused by enterovirus 71 or coxsackievirus A16 and results in asymptomatic infection or mild disease. Immunocompetent adults are rarely affected. Recently, there have been increasing reports of a more severe form of HFMD associated with fevers, joint pains, and widespread painful eruptions. Some of these patients required hospitalization for supportive care. These severe cases were most commonly caused by coxsackievirus A6.

Observations  We describe a 37-year-old white man with widespread, crusted, pruritic papules on the scalp, ears, and face and a purpuric and targetoid painful vesicular eruption on his hands and feet, with associated fevers, neurologic symptoms, and arthritis, who required hospitalization for supportive care. His infection with coxsackievirus A6 was confirmed based on polymerase chain reaction from his oral mucosa and cutaneous vesicle fluid.

Conclusions and Relevance  Dermatologists should be familiar with the severe variant of HFMD caused by coxsackievirus A6, include it in their differential diagnosis of acute febrile blistering diseases, and be aware that certain patients may require hospitalization.

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Figure 1.
Severe Adult Hand-Foot-Mouth Disease in Caused by Coxsackievirus A6

A 37-year-old man developed grouped papules with yellow crust located on the periorificial face (A), occipital scalp (B), and external ear (C). The patient also had purpuric targetoid macules and vesicles on the palms (D) and a fissured scrotum with a fine white scale (E).

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Figure 2.
Biopsy Specimen of the Patient’s Wrist

Biopsy specimen of the patient’s right dorsal wrist vesicle showed an intraepidermal bulla with focal reticular degeneration and confluent necrosis of the blister roof (A, hematoxylin-eosin, original magnification ×4; B, hematoxylin-eosin, original magnification ×20).

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