Coxsackievirus A6 and Hand, Foot and Mouth Disease: Three Case Reports of Familial Child-to-Immunocompetent Adult Transmission and a Literature Review
Case 3: A 21-year-old man, student, with irrelevant medical history, was admitted to our Dermatology Department in April 2013 in compromised physical condition, with a 2-day deteriorating papular and vesicular skin rash accompanied by a 3-day high fever, chills and malaise. Two weeks before developing the symptoms, during a family meeting, the patient had contact with a niece suffering from HFMD. Physical examination showed numerous erythematous papular and vesiculobullous lesions spread throughout the perioral and perinasal zones, oral cavity, on his palms and soles, as well as on the distal lower extremities, up to the knees (fig. , fig. ). A complete blood count revealed lymphocytopenia (1.29 g/l), and the erythrocyte sedimentation rate was increased to 26 mm/h. Blood chemistry tests showed an elevated CRP level (56 mg/l). Syphilis, HIV, Epstein-Barr virus, cytomegalovirus, measles and rubella serologies were negative. The PCR assay confirmed Coxsackievirus A6 both in plasma and in plantar vesicle fluid. Only symptomatic treatment was introduced. After a 3-day hospitalization, the patient's conditions as well as inflammatory parameters improved and he was discharged. After 2 weeks, all the lesions resolved completely. During a 2-month follow-up, no complications were observed.