title: Hand, foot, and mouth syndrome in an immunocompetent adult: a case report.
abstract: BACKGROUND
  Hand, foot, and mouth syndrome (HFMS) is a common acute illness. It is characterized by mild clinical symptoms including fever, blisters, and sores in the mouth and on the palms and soles following a 3- to 7-day incubation period. This syndrome is rarely seen in adults.
  
  
  METHODS
  A 35-year-old male Caucasian patient had a history of multiple episodes of acute pharyngitis, hypertension, hypercholesterolemia, and occasional abdominal pain. He presented with polyarthralgia in the knees and hands and odynophagia, followed by fever, oral mucosal aphthous lesions, and vesicles on the palms and soles. Three weeks after presentation, he was admitted to the emergency room with acute myocarditis. The in-hospital evaluation revealed positive serology for coxsackie A9 (1:160), positive anti-transglutaminase and anti-gliadin antibodies, normal immunoglobulins, and human immunodeficiency virus negativity.
  
  
  CONCLUSIONS
  We herein describe a case of HFMS that was associated with coxsackie A9 infection complicated by acute myocarditis. Although an association between celiac disease and HFMS has not been described, this patient's immunologic disruption could have favored the development of infection and ultimately HFMS.
authors.affiliation: Departments of Infectious Diseases, Hospital de Curry Cabral, Rua da Beneficência n,º 8 1069-166, Lisbon, Portugal. barbara.flordelima@gmail.com.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Flor de Lima
authors.forename: João
authors.initials: J
authors.lastname: Silva
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Rodrigues
authors.forename: Ana
authors.initials: A
authors.lastname: Grilo
authors.forename: Nuno
authors.initials: N
authors.lastname: Riso
authors.forename: Manuel Vaz
authors.initials: MV
authors.lastname: Riscado
mesh_terms: D000208:Acute Disease; D000328:Adult; D002446:Celiac Disease / Q000150:complications / Q000276:immunology* / Q000473:pathology / Q000821:virology; D029822:Enterovirus B, Human / Q000276:immunology / Q000302:isolation & purification*; D006232:Hand, Foot and Mouth Disease / Q000150:complications / Q000276:immunology* / Q000473:pathology / Q000821:virology; D006801:Humans; D007121:Immunocompetence; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000276:immunology* / Q000473:pathology / Q000821:virology