Hand, foot and mouth disease is a systemic infection caused by enteroviruses. It is highly contagious, spreads by direct contact, and is commonly seen in young children. The disease is characterized by ulcerative oral lesions and a vesicular rash on palms, soles and characteristically between the fingers and toes, associated with mild systemic symptoms and signs such as fever and lymphadenopathy.
We present a 35-year-old man referred to a dermatologist with mouth lesions and skin rash. The patient had a fever, followed by a sore throat and malaise, which occurred two days before the rash. Physical examination revealed numerous superficial erosions and small vesicular lesions on the lower lip mucous membrane and on the hard palate, and also, multiple, discrete small vesicular lesions on fingers and toes. The patient was treated symptomatically and all the lesions resolved completely in a week. Adults with hand, foot and mouth disease usually experience milder symptoms than children. In conclusion: the disease should not be overlooked in middle-aged adults with a vesicular rash.
1. Li L, He Y, Yang H, Zhu J, Xu X, Dong J, et al. Genetic characteristics of human enterovirus 71 and Coxsackievirus A16 circulating from 1999 to 2004 in Shenzhen, People’s Republic of China. J Clin Microbiol 2005;43:3835-9.
2. Belazarian L, Lorenzo ME, Pace NC, Sweeney SM, Wiss KM. Exanthematous viral diseases. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, editors. Fitzpatrick′s dermatology in general medicine. 7th ed. New York: Mc Grawe-Hill; 2008. p. 1851-72.
3. Calonje E. Histopathology of the skin: general principles. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s textbook of dermatology. 6th ed. Oxford: Blackwell Publishing Ltd; 2010. p. 10.1-43.
4. Wei SH, Huang YP, Liu MC, Tsou TP, Lin HC, Lin TL, et al. An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010. BMC Infect Dis 2011;11:346.
5. Wu Y, Yeo A, Phoon MC, Tan EL, Poh CL, Quak SH, et al. The largest outbreak of hand, foot and mouth disease in Singapore in 2008: the role of enterovirus 71 and coxsackievirus A strains. Int J Infect Dis 2010;14:e1076-81.
6. Rabenau HF, Richter M, Doerr HW. Hand, foot and mouth disease: seroprevalence of coxsackie A16 and enterovirus 71 in Germany. Med Microbiol Immunol 2010;199(1):45-51.
7. Blomqvist S, Klemola P, Kaijalainen S, Paananen A, Simonen ML, Vuorinen T, et al. Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in Finland. J Clin Virol 2010;48:49-54.
8. Bending JW, Fleming DM. Epidemiological, virological, and clinical features of an epidemic of hand, foot, and mouth disease in England and Wales. Commun Dis Rep CDR Rev 1996;6:R81-6.
9. Shin JU, Oh SH, Lee JH. A case of hand-foot-mouth disease in an immunocompetent adult. Ann Dermatol 2010;22:216-8.
10. Sterling JC. Virus infections. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s textbook of dermatology. 6th ed. Oxford: Blackwell Publishing Ltd; 2010. p. 33.1-81.
11. Baker DA, Philips CA. Fatal hand-foot-and-mouth disease in an adult caused by coxsackievirus 47. JAMA 1979;242:1065