title: Coxsackievirus A6-induced hand-foot-mouth disease.
abstract: OBJECTIVE
  Hand-foot-mouth disease (HFMD) is an acute, self-limited, highly contagious viral illness that commonly affects children younger than 5 years. It is most typically caused by enterovirus 71 or coxsackievirus A16 and results in asymptomatic infection or mild disease. Immunocompetent adults are rarely affected. Recently, there have been increasing reports of a more severe form of HFMD associated with fevers, joint pains, and widespread painful eruptions. Some of these patients required hospitalization for supportive care. These severe cases were most commonly caused by coxsackievirus A6.
  
  
  METHODS
  We describe a 37-year-old white man with widespread, crusted, pruritic papules on the scalp, ears, and face and a purpuric and targetoid painful vesicular eruption on his hands and feet, with associated fevers, neurologic symptoms, and arthritis, who required hospitalization for supportive care. His infection with coxsackievirus A6 was confirmed based on polymerase chain reaction from his oral mucosa and cutaneous vesicle fluid.
  
  
  CONCLUSIONS
  Dermatologists should be familiar with the severe variant of HFMD caused by coxsackievirus A6, include it in their differential diagnosis of acute febrile blistering diseases, and be aware that certain patients may require hospitalization.
authors.affiliation: Department of Dermatology, University of Pennsylvania, School of Medicine, Philadelphia.
authors.forename: Campbell L
authors.initials: CL
authors.lastname: Stewart
authors.affiliation: Department of Dermatology, University of Pennsylvania, School of Medicine, Philadelphia.
authors.forename: Emily Y
authors.initials: EY
authors.lastname: Chu
authors.affiliation: Pennsylvania Centre for Dermatology, Pennsylvania Hospital, Philadelphia.
authors.forename: Camille E
authors.initials: CE
authors.lastname: Introcaso
authors.affiliation: Department of Dermatology, University of Pennsylvania, School of Medicine, Philadelphia.
authors.forename: Andras
authors.initials: A
authors.lastname: Schaffer
authors.affiliation: Department of Dermatology, University of Pennsylvania, School of Medicine, Philadelphia.
authors.forename: William D
authors.initials: WD
authors.lastname: James
mesh_terms: D000328:Adult; D003384:Coxsackievirus Infections / Q000175:diagnosis / Q000503:physiopathology* / Q000821:virology; D003937:Diagnosis, Differential; D029821:Enterovirus A, Human / Q000302:isolation & purification*; D006232:Hand, Foot and Mouth Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000821:virology; D006760:Hospitalization; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D012720:Severity of Illness Index