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Case Reports

Abstract

Hand, foot, and mouth disease (HFMD) is a viral illness caused by Human enteroviruses, especially, coxsackievirus. The disease is characterized by fever and a vesicular rash localized to the hands, feet, mouth, and buttocks. HFMD is highly infectious and prevalent among infants and children under 5 years old. This case presents a unique scenario of HFMD diagnosed in an immunocompetent adult. A 35-year-old male with no significant past medical history presented with a rash that appeared approximately 24 hours after resting in a hot tub with subsequent steam room exposure. The rash was pruritic, preceded by flu-like symptoms one week prior to onset, and was characterized by reddish-brown and violaceous scaly papules involving the bilateral elbows, dorsal hands, palms, abdomen, groin, and lower legs. Infectious disease work up was negative for HIV, HSV, VZV, and syphilis. A punch biopsy of the left dorsal wrist demonstrated focal parakeratosis, epidermal spongiosis, and marked papillary dermal edema associated with extravasated red blood cells with a moderately dense superficial and deep perivascular mixed inflammatory cell infiltrate containing eosinophils. Although the occurrence of HFMD in adults is rare, its incidence has been increasing. Worldwide outbreaks of atypical presentation of the disease in adulthood have been linked to the coxsackie-A6 virus. HFMD should be considered for adults presenting with a rash, especially with the rising number of reported cases. The disease has a heterogenous presentation in adults, making the diagnosis challenging and emphasizing the importance of identifying HFMD.