Enanthems Associated With Uncommon Viral Syndromes

Viral studies were done on 37 patients with enanthems and 17 well persons during the summer and fall of 1966; two-thirds of each group were 3 years old or less. Twenty-nine (84%) of the ill patients and 3 (18%) of the control patients had evidence of viral infection. Although all ill patients were referred to us because of an enanthem, it is significant that the oral signs were often only part of broader disease. The most common concurrent sign was exanthem, found in 17 of 37 ill patients. Six of 11 patients with Coxsackie A4 infection had rash which began with or after defervescence as red macules and papules on the face and trunk and lasted 1 to 4 days before disappearing or becoming vesicular. The vesicular lesions persisted 1 to 2 weeks. Exanthem was also present in Coxsackie B2 and A5-12 associated illnesses. Of 10 patients infected with Coxsackie A 16 virus, 6 had significant submandibular adenopathy, and 2 of 5 with exanthem had urticaria. In several ill patients laboratory findings were unexpected in view of clinical diagnoses. This was particularly true with herpetic stomatitis and incomplete hand, foot, and mouth syndrome.