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CVA6 associated with hand, foot and mouth disease mimicked other disorders
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MIAMI BEACH, Fla. — Coxsackievirus A6, an emerging enterovirus strain associated with severe hand, foot and mouth disease, displayed features that were atypical of the skin disorder but mimicked other childhood dermatologic conditions, according to research presented at the American Academy of Dermatology annual meeting.
“Last year’s [coxsackievirus A6 (CVA6)], hand, foot and mouth disease outbreak offers a reflection of the ever-evolving role that viral pathogens play in dermatological illness, and that CVA6 is becoming an important cause of hand, foot and mouth disease outbreaks worldwide and now in the United States,” researcher Vikash Oza, MD, a dermatology resident at University of California, San Francisco, said during his presentation Saturday.
To better characterize the atypical features of a recent CVA6-associated outbreak in the US, researchers conducted a retrospective case series of 80 pediatric patients at seven dermatology centers from July 2011 to July 2012. Patients who met study criteria either had a positive test for CVA6 (n=17) or met clinical criteria for atypical hand, foot and mouth disease (HFMD; enanthem or exanthem characteristics of HFMD with unusual morphology or extent of cutaneous findings; n=63).
Five distinct morphologies characteristic of the outbreak but not typical of classic HFMD were identified:
- a widespread vesiculobullous and erosive exanthem often involving more than 10% of the body surface area
- an eczema herpeticum-like eruption in atopic dermatitis, which the researchers termed eczema coxsackiuma
- a Gianotti-Crosti-like eruption
- petechial/prupuric eruption
- delayed onychomadesis and the palm and sole desquamation
There were no serious, systemic illnesses observed in the two groups of patients.