Atypical hand, foot and mouth disease with eczematiform presentation in an adult patient

This (Figure 1) is an atypical presentation of hand, foot and mouth disease with eczematiform characteristics in a 35-year old man known for seborrheic dermatitis (Mathes et al., 2013Mathes E.F. Oza V. Frieden I.J. Cordoro K.M. Yagi S. Howard R. et al.“Eczema coxsackium” and unusual cutaneous findings in an enterovirus outbreak.Pediatrics. 2013; 132: e149-57Crossref PubMed Scopus (170) Google Scholar) (inactive before the current consultation). He presented to the emergency department with a 1-week history of sore throat, pruritic cutaneous eruption on his face and low-grade fever. Physical examination revealed multiple well-demarcated erythematous plaques and yellowish scales distributed on areas rich in sebaceous glands such as the face (Figure 1: Panel A) and the scalp (Figure 1: Panel B). There were also vesicular ulcerated lesions around the soft palate (Figure 1: Panel C) and multiple isolated punctiform erythematous macules on his hands (Figure 1: Panel D) and feet, while the rest of the trunk was spared. Laboratory findings were unremarkable. The patient reported that his 1-year old daughter was diagnosed with hand, foot and mouth disease one week before his illness began. Enterovirus was identified with real-time polymerase chain reaction (RT-PCR) (in-house quantitative PCR targeting the well-conserved and important for viral replication 5’ untranslated region) (Romero, 1999Romero J.R. Reverse-transcription polymerase chain reaction detection of the enteroviruses.Arch Pathol Lab Med. 1999; 123: 1161-1169Crossref PubMed Google Scholar) from swabs of his throat and face. Specific enterovirus serotypes have been reported to be associated with wider distribution and more severe disease. Unfortunately, in this case, it was not possible to provide the specific enterovirus serotype as the samples were already discarded at the time of the case reporting. All samples were negative for varicella zoster virus and herpes simplex virus 1 and 2 (tested with RT-PCR). Testing for HIV and Syphilis was also negative. The patient’s symptoms abated with supportive care, and his lesions completely resolved within 2 weeks of his presentation. AK provided patient care, collected the photos and wrote the manuscript. No funding obtained for this work.