Key result
Atypical hand-foot-mouth disease resolves spontaneously with onychomadesis but risks misdiagnosis as eczema herpeticum.
Why the study?
An atypical form of hand-mouth-foot disease with distinct clinical features and onychomadesis has been recently described, but awareness is limited, leading to misdiagnosis and outbreaks.
Case Report (n=1)
No
Atypical hand-foot-mouth disease should be considered in the differential diagnosis of infants presenting with vesiculobullous lesions mimicking eczema herpeticum to prevent unnecessary antiviral therapies and halt nosocomial transmission.
Answers are grounded in this paper and cite their sources.
May warrant considering atypical HFMD in eczema herpeticum differentials; single case leaves open prospective validation before practice change.
Hand-mouth-foot disease is generally caused by Coxsackievirus A16 and Enterovirus 71, which are subtypes of enteroviruses, and it can lead to outbreaks in the people. Recently, an atypical form of disease has been described which consists of different characteristics from classical form. It differs from the classical form of disease with widespread distribution of vesiculobullous skin lesions on the trunk and neck, high rate of ulcerate and bullous formation, crusted and scabbed lesions and onychomadesis. Herein, we reported a 17-month-old child with atypical hand-foot-mouth disease. He was firstly diagnosed with eczema herpeticum, lead to a small outbreak, and healed with onicomadesis. We pointed out atypical enteroviral diseases in infants especially presented with eczema herpeticum and negative tests for herpesviruses. Unnecessary use of acyclovir could be avoided if atypical manifestations of disease are well known. Also, hospital and community outbreaks can be prevented by taking protective measures.
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Kocabaş et al. (2017) conducted a case report in Atypical hand-foot-mouth disease (n=1). Enterovirus infection (suspected Coxsackievirus A6) was evaluated on Clinical healing and development of onychomadesis. The infant and three close contacts developed atypical hand-foot-mouth disease that spontaneously healed with onychomadesis, highlighting the risk of misdiagnosing this enteroviral infection as eczema herpeticum.
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