title: Clinicopathologic analysis of atypical hand, foot, and mouth disease in adult patients.
abstract: BACKGROUND
  Hand, foot, and mouth disease is a contagious viral infection usually affecting children. A resurgence of cases in adults, mainly caused by coxsackievirus A6 and with an atypical and more severe presentation, has taken place.
  
  
  OBJECTIVE
  The goal was to examine the clinical, histologic, and immunohistochemical features of this disease in adults.
  
  
  METHODS
  This is a retrospective study on documented cases of adult hand, foot, and mouth disease from France's Dermatology Department of Strasbourg University Hospital and Bel-Air Hospital in Thionville.
  
  
  RESULTS
  Six patients with severe and atypical presentation were included, 4 caused by coxsackievirus A6. The histologic features were: spongiosis, neutrophilic exocytosis, massive keratinocyte necrosis, shadow cells in the upper epidermis, vacuolization of basal cells, necrotic cells in follicles and sweat glands, dense superficial dermal infiltrate of CD3+lymphocytes, and strong granulysin expression.
  
  
  CONCLUSIONS
  This is a retrospective case series.
  
  
  CONCLUSIONS
  In adult patients presenting with atypical hand, foot, and mouth disease caused by coxsackievirus A6, biopsy specimens show distinctive changes in the epidermis but also in adnexal structures. The inflammatory infiltrate is made of T cells with a cytotoxic profile, with numerous granulysin-positive cells, as observed in severe drug-induced eruption with necrosis of keratinocytes.
authors.affiliation: Clinique Dermatologique, Faculté de Médecine, Université de Strasbourg et Hôpitaux, Universitaires de Strasbourg, Strasbourg, France. Electronic address: julie.second@chru-strasbourg.fr.
authors.forename: Julie
authors.initials: J
authors.lastname: Second
authors.affiliation: Clinique Dermatologique, Faculté de Médecine, Université de Strasbourg et Hôpitaux, Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Velter
authors.affiliation: Service de Dermatologie, Hôpital Bel-Air, Centre Hospitalier Régional Metz-Thionville, Thionville, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Calès
authors.affiliation: Service de Dermatologie, Hôpital Bel-Air, Centre Hospitalier Régional Metz-Thionville, Thionville, France.
authors.forename: François
authors.initials: F
authors.lastname: Truchetet
authors.affiliation: Clinique Dermatologique, Faculté de Médecine, Université de Strasbourg et Hôpitaux, Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Lipsker
authors.affiliation: Clinique Dermatologique, Faculté de Médecine, Université de Strasbourg et Hôpitaux, Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Cribier
mesh_terms: D000328:Adult; D000945:Antigens, Differentiation, T-Lymphocyte / Q000032:analysis; D029821:Enterovirus A, Human / Q000302:isolation & purification; D005260:Female; D005499:Folliculitis / Q000209:etiology / Q000473:pathology; D053804:Granzymes / Q000032:analysis; D018859:Hair Follicle / Q000473:pathology; D006232:Hand, Foot and Mouth Disease / Q000150:complications / Q000473:pathology* / Q000821:virology; D016575:Hidradenitis / Q000209:etiology / Q000473:pathology; D006801:Humans; D015603:Keratinocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000473:pathology / Q000821:virology; D012189:Retrospective Studies; D012867:Skin / Q000737:chemistry / Q000473:pathology; D063189:Symptom Assessment; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology
chemical_list: D000945:Antigens, Differentiation, T-Lymphocyte; C075005:GNLY protein, human; C509213:GZMB protein, human; D053804:Granzymes
keywords: Enterovirus; atypical; coxsackievirus A6; granulysin; hand, foot, and mouth disease; keratinocyte necrosis