Case and Research Letters
Atypical Vesicular-Bullous Hand-Foot-Mouth Disease in 2 Adults
Enfermedad boca-mano-pie atípica vesículo-ampollosa en 2 adultos
Leído
13303
Vecesse ha leído el artículo
1963
Total PDF
11340
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219018301835" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.05.023" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1825" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:567-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731017305598" "issn" => "00017310" "doi" => "10.1016/j.ad.2017.09.011" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1825" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:567-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 211 "formatos" => array:2 [ "HTML" => 136 "PDF" => 75 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Enfermedad boca-mano-pie atípica vesículo-ampollosa en 2 adultos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "567" "paginaFinal" => "569" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Atypical Vesicular-Bullous Hand-Foot-Mouth Disease in 2 Adults" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1736 "Ancho" => 1867 "Tamanyo" => 642826 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presentación clínica correspondiente al caso 1: a) Costras melicéricas en región perioral; b) Máculas eritematosas plantares. Presentación clínica correspondiente al caso 2; c) Pápulas eritematosas en dorso de manos; d) Pápulas eritematosas aisladas y confluentes en región distal del dorso de ambos pies.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Á. Iglesias-Puzas, A. Batalla, M. Trigo, Á. Flórez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Á." "apellidos" => "Iglesias-Puzas" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Batalla" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Trigo" ] 3 => array:2 [ "nombre" => "Á." "apellidos" => "Flórez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018301835" "doi" => "10.1016/j.adengl.2018.05.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301835?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305598?idApp=UINPBA000044" "url" => "/00017310/0000010900000006/v1_201808010427/S0001731017305598/v1_201808010427/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219018301756" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.05.017" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1824" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:570-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 17 "formatos" => array:2 [ "HTML" => 15 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Value of Ultrasound as a Diagnostic Tool for a Painful Thoracic Nodule" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "570" "paginaFinal" => "573" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la ecografía en el diagnóstico diferencial de un nódulo doloroso en el tórax" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 698 "Ancho" => 1996 "Tamanyo" => 215763 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Dermatoscopy (DermLite II Pro HR, 3<span class="elsevierStyleHsp" style=""></span>Gen): central blue-violaceous area surrounded by an erythematous halo. B, Well-differentiated polylobulated tumor in the dermis (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2). C, The tumor is composed of a biphasic epithelial proliferation comprising small cells arranged around cells with more abundant and clearer cytoplasm that forms ductal structures. No atypia or mitosis is visible (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Morgado-Carrasco, S. Gómez, L. Alós, P. Giavedoni" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Gómez" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Alós" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Giavedoni" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305586" "doi" => "10.1016/j.ad.2017.09.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305586?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301756?idApp=UINPBA000044" "url" => "/15782190/0000010900000006/v1_201808010420/S1578219018301756/v1_201808010420/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018301628" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.05.005" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1826" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:565-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 14 "formatos" => array:2 [ "HTML" => 8 "PDF" => 6 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Response to Secukinumab after Treatment Failure with Ustekinumab in 6 Patients with Plaque Psoriasis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "565" "paginaFinal" => "567" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta a secukinumab tras fracaso terapéutico con ustekinumab en seis pacientes con psoriasis en placas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 828 "Ancho" => 2185 "Tamanyo" => 151810 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Response to treatment with secukinumab in patients with an unacceptable response to treatment with ustekinumab.PASI, Psoriasis Area and Severity Index; SEC, secukinumab.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Morgado-Carrasco, J. Riera-Monroig, X. Fustà-Novell, M. Alsina Gibert" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Riera-Monroig" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Fustà-Novell" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Alsina Gibert" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305604" "doi" => "10.1016/j.ad.2017.07.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305604?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301628?idApp=UINPBA000044" "url" => "/15782190/0000010900000006/v1_201808010420/S1578219018301628/v1_201808010420/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Atypical Vesicular-Bullous Hand-Foot-Mouth Disease in 2 Adults" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "567" "paginaFinal" => "569" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Á. Iglesias-Puzas, A. Batalla, M. Trigo, Á. Flórez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Á." "apellidos" => "Iglesias-Puzas" "email" => array:1 [ 0 => "alvaroigpu@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Batalla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Trigo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Á." "apellidos" => "Flórez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, EOXI Pontevedra-Salnés, Pontevedra, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología, Complejo Hospitalario Universitario de Pontevedra, EOXI Pontevedra-Salnés, Pontevedra, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad boca-mano-pie atípica vesículo-ampollosa en 2 adultos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1736 "Ancho" => 1867 "Tamanyo" => 644335 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1 clinical presentation: A, Honey-colored crusts around the mouth; B, Erythematous macules on the soles of the feet. Case 2 clinical presentation: C, erythematous papules on the dorsum of the hands; D, Isolated and confluent erythematous papules on the dorsum of both feet with a distal distribution.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hand-foot-and-mouth disease (HFMD)is an exanthematic disease that predominantly affects children.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The classic form presents with fever, small vesicles on the hands and feet, and oropharyngeal erosions with a self-limited course.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In recent years, atypical forms of the disease have acquired clinical and epidemiological importance. These are characterized by a wide array of clinical presentations, unusual distribution, and greater severity than the classic forms.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report 2 cases of adults diagnosed with atypical, vesicular-bullous HFMD caused by <span class="elsevierStyleItalic">Coxsackievirus</span> A6. The epidemiological, clinical (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and histological (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) data, as well as the course and treatment of both patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">HFMD is a common, self-limited disease generally associated with infection with <span class="elsevierStyleItalic">Coxsackievirus</span> A16 or <span class="elsevierStyleItalic">Enterovirus</span> A71.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> However, these serotypes have been responsible for epidemic outbreaks of HFMD and have been associated with fatal complications, including encephalitis and acute non-cardiogenic pulmonary edema. Recent years have seen the emergence of enteroviruses with scant dermal tropism associated with serious respiratory and neurological conditions (<span class="elsevierStyleItalic">Coxsackievirus</span> D68 and D70), and serotypes that cause atypical HFMD have become more prominent (<span class="elsevierStyleItalic">Coxsackievirus A6).</span><a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">HFMD is more common in summer and predominantly affects children under 5 years of age.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Symptomatic skin infection with these viruses is unusual in adults,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> probably because of immune memory due to past infections or cross immunity with other enteroviruses.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Diagnosis of these infections in older adults is usually associated with atypical variants and more virulent serotypes, such as <span class="elsevierStyleItalic">Coxsackievirus</span> A6.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Classic HFMD is characterized by fever accompanied by small vesicles and erosions that affect the oral mucosa, hands, feet, and buttocks and resolve in 7-10 days without scarring.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3,5,8</span></a> Systemic complications such as poliomyelitis, myocarditis, and meningeal syndrome are exceptional.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Atypical forms usually occur in adults and present with fever, vesicular-bullous lesions, erosions, and scabs affecting over 5% of the body surface area. Lesion distribution is predominantly acral and there is often involvement of the scalp and perioral region (but little intraoral involvement).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> During the course of the disease, lesions may affect the neck, trunk, forearms, or legs.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4,8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">To date, 4 atypical forms of HFMD have been reported: <span class="elsevierStyleItalic">coxsackium</span> eczema (vesicles and erosions in areas of atopic eczema); an eruption similar to that of Gianotti-Crosti syndrome (papulovesicles and erosions on the cheeks, buttocks, and extensor regions but sparing the trunk); a petachial and purpuric form (predominantly acral in patients over 5 years of age); and the vesicular-bullous variant described in this case. Late skin manifestations include onychomadesis, Beau's lines, and acral scaling.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Diagnosis is clinical. The infection can be confirmed by analysis of skin vesicle content using reverse transcriptase polymerase chain reaction (RT-PCR). In samples of pharyngeal exudate, the viral load is often lower but such samples can remain positive for several weeks.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Histologic findings include spongiosis with intraepidermal vesiculation, neutrophil exocytosis, pale and necrotic keratinocytes, and occasionally phantom cells. In the dermis, edema and a predominantly lymphocytic inflammatory infiltrate with granulysin expression can be observed, but not viral inclusion bodies or giant cells.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Atypical forms of HFMD may mimic other viral diseases, (herpetic infections, Gianotti-Crosti syndrome, purpuric glove and sock syndrome), other types of infections (syphilis, blistering impetigo, erythema multiforme), and adverse drug reactions.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Given the self-limited nature of HFMD, in most cases the clinical care required is symptomatic treatment to keep the skin hydrated and pain control if necessary. Hand hygiene measures should be recommended. When there is evidence of superinfection, this should be treated.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In summary, we report 2 cases of atypical HFMD. The incidence of atypical HFMD is increasing. These variants are more prevalent among adults and the resulting disease is more severe. HFMD should therefore be suspected and included in the differential diagnosis of a patient presenting with fever, vesicular-bullous lesions, erosions, and crusts on the palms and soles or around the mouth.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Iglesias-Puzas Á, Batalla A, Trigo M, Flórez Á. Atypical Vesicular-Bullous Hand-Foot-Mouth Disease in 2 Adults. Actas Dermosifiliogr. 2018;109:567–569.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1736 "Ancho" => 1867 "Tamanyo" => 644335 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1 clinical presentation: A, Honey-colored crusts around the mouth; B, Erythematous macules on the soles of the feet. Case 2 clinical presentation: C, erythematous papules on the dorsum of the hands; D, Isolated and confluent erythematous papules on the dorsum of both feet with a distal distribution.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1607 "Ancho" => 1200 "Tamanyo" => 503454 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Results of histologic examination in Case 1: A, epidermal detachment (hematoxylin-eosin ×40); B, Spongiosis, vacuolar degeneration of the basal layer, and neutrophil exocytosis (hematoxylin-eosin ×70).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None of interest \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None of interest \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever and odynophagia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Low-grade fever \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Skin lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Erythematous-violaceous papules with vesiculation<br>Non-metmeric, honey-colored, patchy serous crusts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Erythematous-violaceous vesiculated papules on the skin surface<br>Pseudo target lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Distribution \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palms, soles, dorsum of hands, distal region of forearms and perioral region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palms, soles, and dorsum of the hands and feet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mucosal involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Petechiae on the palate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pharyngeal erythema \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serotype<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Coxsackievirus</span> A6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Coxsackievirus</span> A6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes: spongiosis, basal membrane degeneration, isolated epidermal necrosis, and perivascular lymphocytic infiltrate. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical corticosteroids and oral antihistamines<br>Crust removal and oral amoxicillin-clavulanic acid 875 mg/8 h for 10 days<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical corticosteroids and oral antihistamines \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anonychia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other late Manifestations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acral desquamation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acral desquamation \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1819472.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Enterovirus positivity revealed by polymerase chain reaction with reverse transcriptase (RT-PCR). <span class="elsevierStyleItalic">Coxsackievirus</span> A6 identified by genotyping.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Crust removal and oral antibiotic therapy were indicated because of suspected bacterial superinfection.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the 2 Cases of Atypical Hand-Foot-Mouth Disease.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on hand-foot-and-mouth disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Ventarola" 1 => "L. Bordone" 2 => "N. Silverberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2014.12.011" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "340" "paginaFinal" => "346" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25889136" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unusual skin manifestation of hand, foot and mouth disease associated with coxsackievirus A6: Cases report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Chatproedprai" 1 => "T. Tempark" 2 => "N. Wanlapakorn" 3 => "J. Puenpa" 4 => "S. Wananukul" 5 => "Y. Poovorawan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40064-015-1143-z" "Revista" => array:5 [ "tituloSerie" => "Springerplus" "fecha" => "2015" "volumen" => "4" "paginaInicial" => "362" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26203408" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coxsackievirus A6 associated hand, foot and mouth disease in adults: Clinical presentation and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Downing" 1 => "M.K. Ramirez-Fort" 2 => "H.Q. Doan" 3 => "F. Benoist" 4 => "M.S. Oberste" 5 => "F. Khan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcv.2014.04.023" "Revista" => array:6 [ "tituloSerie" => "J Clin Virol" "fecha" => "2014" "volumen" => "60" "paginaInicial" => "381" "paginaFinal" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24932735" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eczema coxsackium and unusual cutaneous findings in an enterovirus outbreak" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.F. Mathes" 1 => "V. Oza" 2 => "I.J. Frieden" 3 => "K.M. Cordoro" 4 => "S. Yagi" 5 => "R. Howard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatrics" "fecha" => "2013" "volumen" => "132" "paginaInicial" => "149" "paginaFinal" => "157" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatological spectrum of hand, foot and mouth disease from classical to generalized exanthema" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Hubiche" 1 => "I. Schuffenecker" 2 => "F. Boralevi" 3 => "C. Leaute-Labreze" 4 => "L. Bornebusch" 5 => "C. Chiaverini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/INF.0000000000000171" "Revista" => array:6 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "2014" "volumen" => "33" "paginaInicial" => "92" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24346598" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enteroviruses in the early 21st century: New manifestations and challenges" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Lugo" 1 => "P. Krogstad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MOP.0000000000000303" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pediatr" "fecha" => "2016" "volumen" => "28" "paginaInicial" => "107" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26709690" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical presentation of enterovirus infection in adults: outbreak of ‘hand, foot, mouth and scalp disease’ in Northern Italy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Balestri" 1 => "M. Bellino" 2 => "L. Landini" 3 => "L. Tasin" 4 => "L. Rizzoli" 5 => "L. Speziali" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.14507" "Revista" => array:2 [ "tituloSerie" => "J Eur Acad Dermatol Venereol." "fecha" => "2017" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical hand, foot, and mouth disease: A vesiculobullous eruption caused by Coxsackie virus A6" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.M. Feder Jr." 1 => "N. Bennett" 2 => "J.F. Modlin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(13)70264-0" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "83" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24287184" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopatología de las infecciones víricas cutáneas más frecuentes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Requena" 1 => "C. Requena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2010" "volumen" => "101" "paginaInicial" => "201" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20398595" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Epub 2016/12/29" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinicopathologic analysis of atypical hand, foot, and mouth disease in adult patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Second" 1 => "C. Velter" 2 => "S. Cales" 3 => "F. Truchetet" 4 => "D. Lipsker" 5 => "B. Cribier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2016.10.022" "Revista" => array:2 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2016" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000006/v1_201808010420/S1578219018301835/v1_201808010420/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000006/v1_201808010420/S1578219018301835/v1_201808010420/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301835?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 24 | 8 | 32 |
| 2024 Octubre | 237 | 45 | 282 |
| 2024 Septiembre | 200 | 27 | 227 |
| 2024 Agosto | 180 | 61 | 241 |
| 2024 Julio | 164 | 40 | 204 |
| 2024 Junio | 150 | 32 | 182 |
| 2024 Mayo | 160 | 52 | 212 |
| 2024 Abril | 142 | 35 | 177 |
| 2024 Marzo | 193 | 30 | 223 |
| 2024 Febrero | 251 | 30 | 281 |
| 2024 Enero | 304 | 44 | 348 |
| 2023 Diciembre | 369 | 24 | 393 |
| 2023 Noviembre | 445 | 43 | 488 |
| 2023 Octubre | 496 | 32 | 528 |
| 2023 Septiembre | 434 | 45 | 479 |
| 2023 Agosto | 380 | 19 | 399 |
| 2023 Julio | 420 | 41 | 461 |
| 2023 Junio | 345 | 28 | 373 |
| 2023 Mayo | 325 | 33 | 358 |
| 2023 Abril | 253 | 26 | 279 |
| 2023 Marzo | 261 | 40 | 301 |
| 2023 Febrero | 246 | 28 | 274 |
| 2023 Enero | 193 | 20 | 213 |
| 2022 Diciembre | 187 | 37 | 224 |
| 2022 Noviembre | 162 | 34 | 196 |
| 2022 Octubre | 152 | 25 | 177 |
| 2022 Septiembre | 154 | 50 | 204 |
| 2022 Agosto | 119 | 39 | 158 |
| 2022 Julio | 96 | 36 | 132 |
| 2022 Junio | 85 | 39 | 124 |
| 2022 Mayo | 177 | 49 | 226 |
| 2022 Abril | 263 | 46 | 309 |
| 2022 Marzo | 287 | 59 | 346 |
| 2022 Febrero | 265 | 40 | 305 |
| 2022 Enero | 323 | 45 | 368 |
| 2021 Diciembre | 380 | 51 | 431 |
| 2021 Noviembre | 344 | 49 | 393 |
| 2021 Octubre | 351 | 59 | 410 |
| 2021 Septiembre | 280 | 39 | 319 |
| 2021 Agosto | 266 | 43 | 309 |
| 2021 Julio | 202 | 29 | 231 |
| 2021 Junio | 130 | 21 | 151 |
| 2021 Mayo | 80 | 57 | 137 |
| 2021 Abril | 137 | 48 | 185 |
| 2021 Marzo | 103 | 26 | 129 |
| 2021 Febrero | 90 | 35 | 125 |
| 2021 Enero | 59 | 17 | 76 |
| 2020 Diciembre | 63 | 21 | 84 |
| 2020 Noviembre | 58 | 24 | 82 |
| 2020 Octubre | 50 | 35 | 85 |
| 2020 Septiembre | 77 | 16 | 93 |
| 2020 Agosto | 60 | 20 | 80 |
| 2020 Julio | 53 | 16 | 69 |
| 2020 Junio | 40 | 28 | 68 |
| 2020 Mayo | 29 | 22 | 51 |
| 2020 Abril | 25 | 17 | 42 |
| 2020 Marzo | 17 | 8 | 25 |
| 2020 Febrero | 3 | 0 | 3 |
| 2019 Mayo | 1 | 0 | 1 |
Mostrar todo
