Unusual skin manifestation of hand, foot and mouth disease associated with coxsackievirus A6: cases report

Susheera Chatproedprai, Therdpong Tempark, Nasamon Wanlapakorn, Jiratchaya Puenpa, Siriwan Wananukul, Yong Poovorawan

Hand, food, and mouth disease (HFMD) is a highly contagious disease caused by enteroviruses infection. It is a health problem in young children under 5 years of age worldwide. The common causative agents are coxsackievirus A 16 (CA16) and enterovirus 71 (EV71). In recent years, coxsackievirus A6 (CA6) has emerged to be one of the major etiologic agents of HFMD worldwide including in Thailand. We reported cases with unusual skin manifestations of CA6-associated HFMD such as widespread severe cutaneous eruption, large vesicles (varicelliform), purpuric-like lesions or Gianotti-Crosti like eruptions. Molecular characterization of the CA6 strains from those patients found that all were clustered in the same group of CA6 that are currently circulating in Thailand. Clinicians need to be aware of the expanded range of cutaneous findings in CA6-associated HFMD in order to properly consider the diagnosis, management and prevention.