title: Atypical hand-foot-and-mouth disease associated with coxsackievirus A6 infection.
abstract: BACKGROUND
  Hand-foot-and-mouth disease (HFMD) is an acute viral illness commonly caused by coxsackievirus (CV)-A16 and enterovirus 71 infections. Recently, atypical HFMD has been reported in association with CV-A6, an uncommon enterovirus strain.
  
  
  OBJECTIVE
  We sought to describe the clinical features of atypical HFMD associated with CV-A6 infection and its diagnostic laboratory evaluation.
  
  
  METHODS
  Patients presenting to our institution with history and examination suggestive of atypical HFMD from January 2012 to July 2012 were identified. Morphology and distribution of mucocutaneous lesions were recorded. Enterovirus infection was assessed by reverse transcriptase polymerase chain reaction of biologic specimens. Enterovirus type was determined by viral capsid protein 1 gene sequencing.
  
  
  RESULTS
  Two adults and 3 children with atypical HFMD were identified. Four of 5 patients exhibited widespread cutaneous lesions. In 2 patients with a history of atopic dermatitis, accentuation in areas of dermatitis was noted. Associated systemic symptoms prompted 4 of 5 patients to seek emergency care, and both adults were hospitalized for diagnostic evaluation. Infection with CV-A6 was confirmed in all patients.
  
  
  CONCLUSIONS
  This study is a case series from a single institution.
  
  
  CONCLUSIONS
  Consideration of the expanded range of cutaneous findings in atypical HFMD caused by CV-A6 infection may assist clinicians in diagnosis and management.
authors.affiliation: Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Lott
authors.affiliation: Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Kristina
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Landry
authors.affiliation: Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: W Allan
authors.initials: WA
authors.lastname: Nix
authors.affiliation: Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: M Steven
authors.initials: MS
authors.lastname: Oberste
authors.affiliation: Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Jean
authors.initials: J
authors.lastname: Bolognia
authors.affiliation: Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut. Electronic address: brett.king@yale.edu.
authors.forename: Brett
authors.initials: B
authors.lastname: King
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003384:Coxsackievirus Infections / Q000150:complications*; D029821:Enterovirus A, Human; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000150:complications* / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D055815:Young Adult
keywords: AD; CDC; CV; Centers for Disease Control and Prevention; ED; HFMD; PCR; RT; atopic dermatitis; atypical; coxsackievirus; coxsackievirus A6; diagnosis; emergency department; enterovirus; evaluation; exanthem; hand-foot-and-mouth disease; polymerase chain reaction; reverse transcriptase
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