Atypical Hand, Foot and Mouth Disease

Background: Hand, foot and mouth disease (HFMD) is a contagious viral syndrome, which mainly affects infants and young children, and is caused by different enterovirus serotypes. The viruses are usually transmitted by the fecal-oral route and its typical presentation is oral enanthem and a macular, maculopapular, or vesicular rash of the hands and feet, and sometimes in other locations, such as buttocks, legs, arms, and rarely in genitalia. We here report an atypical manifestation of an otherwise common syndrome.

Case Presentation Summary: A 5 year-old-girl was admitted to the paediatric emergency room with a 24-hour history of erythematous macular lesions in the groin with extreme itchiness. On examination, she had multiple vesicles, some of them already eroded, surrounded by an erythematous halo. Throughout her stay, new macules and vesicles appeared on her genitalia, bottom, hands, mouth and feet; after a period of 24 hours, all lesions had formed into scabs. Given the appearance of the skin lesions and the symptoms, it was hypothesized an atypical HFMD. This case could have been easily mistaken for other clinical entities, such as Eczema herpeticum and Varicella, given that it was an itchy rash, or Henoch-Schonlein Purpura, due to the rash distribution. In this case, given its atypical presentation, a stool sample was collected and the etiological confirmation of an enterovirus infection was obtained through nucleic acid amplification.
The patient remained hospitalized for 2 days with supportive therapy and medicated with antihistaminic only. With no further complications, she was discharged.

Conclusion: Currently there is no specific treatment available for enteroviruses. HFMD is usually a self-limited and benign syndrome, however given its potentially severe complications, physicians should be aware of its different presentations.