Enteroviruses constitute a common cause of infection in neonates and infants younger than 3 months, manifesting with various exanthems and enanthems, including herpangina, purpura, urticaria-like and maculopapular eruptions. Some clinical syndromes (viral meningitis and some exanthema) are caused by numerous enterovirus serotypes, while others appear limited to specific enterovirus subgroups.
We describe two cases of young infants presenting with a unique finding on the physical examination. Patient #1 is a five weeks-old male infant who was admitted for full sepsis-workup following neonatal fever. Pregnancy and delivery were uncomplicated, and he had no risk factors for serious bacterial infection. Upon presentation, he was a well-appearing child with no abnormal physical findings. Initial laboratory evaluation was reassuring, however, during his hospitalization, he became ill-appearing and irritable. On the fourth day, the mother noted red, swollen and tender feet, resembling erythromelalgia (Figures 1,2), which subsided gradually. Patient #2 was also admitted for full sepsis-workup due to neonatal fever, with initial tests within normal limits. On the fourth day, the mother noted persistent crying and irritability, as well as red and tender feet (Figures 3,4). Both patients had positive CSF PCR analysis for Enterovirus. Later, subtype classification was made for both specimens, revealing surprisingly, an infection with the same serotype – Echovirus 16.
Maculopapular rash involving the palms and soles is a very common Enteroviral infection manifestation. Nevertheless, an isolated hyperemic, tender and swollen erythromelalgic appearance of the feet as a diagnostic clue for Enteroviral infection has yet to be described in the literature.
