Presentación atípica de la Enfermedad Gloso-Mano-Peda en pacientes atópicos.

Published in Dermatology

Journal Scan / Research · January 30, 2018

Atypical Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6

Acta Dermato-Venereologica

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• The authors evaluated 23 cases of atypical hand, foot, and mouth disease (HFMD), including 15 adults and 8 children, 1 of whom was thought to have a diagnosis other than HFMD. The 15 adult patients all had vesicles and involvement of dorsal and palmar hands; 80% had fever and oral mucosal symptoms, 87% had facial involvement, and 27% had involvement of soles. The children all (100%) had fever, and 75% had involvement of hands and feet. A total of 3 adults and 3 children required hospitalization due to extensive skin involvement and fever. Enterovirus was identified on sampling, and 13 cases tested positive for coxsackievirus A6. 

• These results indicate that atypical HFMD may be challenging to diagnose, as it can mimic many other severe skin diseases.

  – InYoung Kim, MD

 Dermatology

Written by

 

 

Lisa Y Shen MD

This article highlights the increasing prevalence and distinct presentation of atypical hand, foot, and mouth disease (HFMD) in Denmark. This parallels the increasing number of coxsackievirus A6 (CV-A6)–associated HFMD cases reported in the US.1 The authors note a distribution of vesicular lesions on the extremities (especially the dorsal hands) and face (specifically the perioral region in children). Of note, the cutaneous eruption can also be quite petechial and purpuric, being commonly mistaken for vasculitis. This eruption is seen more in atopic children, and affected children can develop onychomadesis weeks later, as previously reported with classical HFMD.2 Atypical HFMD can be quite extensive, with diffuse vesicles and bullae, which can be mistaken for herpes simplex, erythema multiforme, and Steven-Johnson syndrome. This article stresses the importance of recognizing atypical HFMD in order to avoid unnecessary treatment or hospitalization and prevent the spread of this highly contagious virus.

This atypical viral exanthem has become much more common and easily recognized in the US and is a frequent photo consult from our own and referring emergency departments. Asking about exposure to HFMD may help shed light on this diagnosis. Because the eruption is sometimes dramatic and severe in appearance, we need to recognize this, understand its seasonality, and reassure families and their referring providers.

References 

1. Mathes EF, Oza V, Frieden IJ, et al. "Eczema coxsackium" and unusual cutaneous ndings in an enterovi- rus outbreak. Pediatrics 2013;132(1):e149–157. http://pediatrics.aappublications.org/content/132/1/e149
2. Clementz GC, Mancini AJ. Nail matrix arrest following hand-foot-mouth disease: a report of five children. Pediatr Dermatol. 2000;17(1):7-11. http://onlinelibrary.wiley.com/wol1/doi/10.1046/j.1525-1470.2000.01702.x/full

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Abstract

Since 2008, outbreaks of atypical hand, foot, and mouth disease (HFMD) in children and adults have been reported worldwide. The majority of these outbreaks are caused by a new lineage of Coxsackie virus A6 (CV-A6) presenting a more severe clinical phenotype than the classical childhood HFMD caused by CV-A16. Between June 2014 and January 2016, 23 cases of atypical HFMD disease presented at a Dermatology Department at a regional University Hospital in Denmark. Patients were referred by general practitioners and dermatologists with a variety of clinical diagnoses, including eczema herpeticum, vasculitis, syphilis, dermatophytid, erythema multiforme and Stevens-Johnson syndrome. Three adults and 3 children required hospitalization due to extensive skin involvement and fever. All reported patients had laboratory confirmed enterovirus infection. This study demonstrated an upsurge in atypical HFMD caused by CV-A6 in the Region of Southern Denmark and that atypical HFMD can be difficult to diagnose clinically as it may mimic other severe skin diseases.

Copyright © 2018 Elsevier Inc. All rights reserved.

Additional Info

• Article Citation

Acta Dermato-Venereologica

Atypical Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6 in Denmark: A Diagnostic Mimicker

Acta Derm Venereol 2017 Nov 28;[EPub Ahead of Print], HH Horsten, M Kemp, TK Fischer, KH Lindahl, A Bygum