DermatopathologyClinicopathologic analysis of atypical hand, foot, and mouth disease in adult patients
Section snippets
Methods
We performed a retrospective study of HFMD in adults occurring between July 2011 and July 2015 in 2 French dermatology departments. The patients were selected by consultation of hospitalization files, photographs, or biopsy specimens.
The criteria for inclusion were: age 18 years or older and HFMD proven by serology, positive polymerase chain reaction for enterovirus RNA, or a suggestive clinical picture with performance of a skin biopsy. The clinical criteria required in the absence of
Results
Nine cases were identified, of which 3 were excluded owing to the absence of virologic confirmation or biopsy specimen.
The main clinical data are presented in Table I. All patients had painful or pruritic erythematous lesions (sometimes grayish) and palmoplantar papulovesicles that spread to the back of the hands or feet (Fig 1, A and B). One had bullous lesions (Fig 1, B). In 5 patients the skin was diffusely affected: face (Fig 1, C), scalp, buttocks, thighs, genitalia, back, and upper limbs.
Discussion
HFMD is generally linked to coxsackievirus A16 or enterovirus 71. Its typical form usually results in moderate fever, vesicular enanthem of the oral mucosa, followed by a palmoplantar papulovesicular eruption, after an incubation period of 3 to 5 days. Recovery is spontaneous in 7 to 10 days.
Coxsackievirus A6 is generally responsible for herpangina. Since 2008, coxsackievirus A6–associated HFMD have become more frequent, with outbreaks in many countries, frequently affecting adults.12, 13, 14,
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Detecting Lesional Granulysin Levels for Rapid Diagnosis of Cytotoxic T lymphocyte–Mediated Bullous Skin Disorders
2021, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :In addition, pathological examination using immunohistochemistry has revealed strong positive staining for CD8 and CD56, with granulysin in epidermal blisters.9 Another retrospective study has assessed the expression of granulysin by immunohistochemical evaluation in 6 adult-onset hand, foot, and mouth disease cases caused by the coxsackievirus A6 without obvious blistering, and demonstrated apparent granulysin mainly in the infiltrate around vessels of the papillary dermis, rather than within the epidermis.39 Interestingly, we identified 1 case of GvHD presenting bullous formation mimicking SJS/TEN, with an elevated granulysin level (228.7 ng/mL) in the blister fluid.
Cutaneous manifestations of enterovirus infections: An expanding clinical spectrum
2020, Annales de Dermatologie et de VenereologieAtypical hand, foot and mouth disease in adults: A note on 6 cases
2020, Annales de Dermatologie et de VenereologieManagement guidelines for pregnant health care workers exposed to infectious dermatoses
2020, International Journal of Women's DermatologyCitation Excerpt :Other features include widespread vesiculobullous and erosive lesions extending beyond the palms and soles, an eczema herpeticum-like eruption termed “eczema coxsackium,” and an eruption similar to Gianotti-Crosti in children (Mathes et al., 2013). There can also be occasional sparing of the oral mucosa (Second et al., 2017). Outbreaks of HFMD in adults that have been reported in the literature have typically occurred in adults after exposure to children with HFMD (Centers for Disease Control and Prevention [CDC] Morbidity and Mortality Weekly Report, 2012) or among college students (Buttery et al., 2015) and military trainees (Banta et al., 2016).
Funding sources: None.
Conflicts of interest: None declared.