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Case Report
Medwave 2019;19(7) doi: 10.5867/medwave.2019.07.7683
A case report of hand, foot, and mouth disease with necrotizing mucocutaneous lesions
Janett Velástegui, Ligia Cova, Yomaira Galarza, Pablo Fierro, Lenier León Baryolo, Alberto Bustillos
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Key Words: hand, foot and mouth disease, necrosis, enterovirus

Abstract

In most cases, the cause of hand, foot, and mouth disease (HFMD) is coxsackievirus A type 16. The infection can also be caused by other strains of coxsackievirus, spreading mainly by the oral-fecal route, while it is less likely to be transmitted through secretions. HFMD occurs mainly in summer and is more common in children under ten. Skin lesions develop during the disease but rarely become necrotic. When present, they are a severe complication requiring hospitalization. This paper reports the case of a patient with HFMD who developed necrotic mucocutaneous lesions that responded favorably to intravenous acyclovir, fluids, and electrolyte support therapy.


 

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Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

La enfermedad de mano-pie-boca es una patología originada en la mayoría de los casos por el virus coxsackie A tipo 16, aunque también puede ser ocasionada por otras cepas de la familia de los coxsackievirus. Dicho virus se propaga principalmente por vía fecal oral y, en menor proporción, por secreciones. Se presenta principalmente en verano, siendo frecuente en niños menores de 10 años. Dentro de dicha enfermedad las lesiones mucocutáneas que evolucionen en necrosis son poco frecuentes, constituyéndose en una complicación severa que requiere hospitalización. En el presente artículo se reporta un caso con diagnóstico de enfermedad mano-pie-boca, que evolucionó hacia lesiones mucocutáneas necróticas, mostrando una respuesta favorable a una terapia de soporte de aciclovir, líquidos y electrolitos.

Autores: Janett Velástegui[1], Ligia Cova[1], Yomaira Galarza[1], Pablo Fierro[1], Lenier León Baryolo[2], Alberto Bustillos[1]

Affiliation:
[1] Hospital General Docente Ambato, Unidad de Pediatría, Ambato, Ecuador
[2] Carrera de Medicina, Facultad de Ciencias de la Salud, Universidad Técnica de Ambato, Ambato, Ecuador

E-mail: aa.bustillos@uta.edu.ec

Author address:
[1] Avenida Colombia y Chile
CP 180104
Ambato
Tungurahua
Bolivia

Citation: Velástegui J, Cova L, Galarza Y, Fierro P, León Baryolo L, Bustillos A. A case report of hand, foot, and mouth disease with necrotizing mucocutaneous lesions. Medwave 2019;19(7) doi: 10.5867/medwave.2019.07.7683

Submission date: 19/3/2019

Acceptance date: 7/7/2019

Publication date: 14/8/2019

Origin: not commissioned

Type of review: reviewed by two external peer reviewers, double-blind

PubMed record

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  1. Zeng H, Lu J, Zheng H, Yi L, Guo X, Liu L, et al. The Epidemiological Study of Coxsackievirus A6 revealing Hand, Foot and Mouth Disease Epidemic patterns in Guangdong, China. Sci Rep. 2015 May 21;5:10550. | CrossRef | PubMed |
  2. Stewart CL, Chu EY, Introcaso CE, Schaffer A, James WD. Coxsackievirus A6-induced hand-foot-mouth disease. JAMA Dermatol. 2013 Dec;149(12):1419-21. | CrossRef | PubMed |
  3. Cisterna DM, Lema CL, Martinez LM, Verón E, Contarino LP, Acosta D, et al. Atypical hand, foot, and mouth disease caused by Coxsackievirus A6 in Argentina in 2015. Rev Argent Microbiol. 2019 Apr - Jun;51(2):140-143. | CrossRef | PubMed |
  4. Larralde M, Aristizábap AM. Enfermedad mano-pie-boca. Arch Argent Dermatol. 2005;25-9. | Link |
  5. Cabrera D, Anet E, Plasencia R, Espinosa L. Enfermedad boca mano pie . Presentación de un caso Foot , hand and mouth disease . Case presentation. Medisur. 2018;469-74. | Link |
  6. Koh WM, Badaruddin H, La H, Chen MI, Cook AR. Severity and burden of hand, foot and mouth disease in Asia: a modelling study. BMJ Glob Health. 2018 Jan 26;3(1):e000442. | CrossRef | PubMed |
  7. Martines, Virginia; Laureano M. Enfermedad mano-pie-boca. Presentación de un caso y breve revisión de la literatura. Rev Cent Dermatol Pascua. 1999;8:21-4. | Link |
  8. Bennesch M, Fernández P, Salvaneschi B. Enfermedad mano-pie-boca del adulto, emergencia del Coxsackie A6. Dermatología Argentina. 2017;23:183-7. | Link |
  9. Silvente C, Valdivielso M, Hernanz JM. Enfermedad mano-pie-boca. 2010;68(2):85-7. | Link |
  10. Sasaki O, Karaki T, Imanishi J. Protective effect of interferon on infections with hand, foot, and mouth disease virus in newborn mice. J Infect Dis. 1986 Mar;153(3):498-502. | PubMed |
  11. Lin H, Huang L, Zhou J, Lin K, Wang H, Xue X, et al. Efficacy and safety of interferon-α2b spray in the treatment of hand, foot, and mouth disease: a multicenter, randomized, double-blind trial. Arch Virol. 2016 Nov;161(11):3073-80. | CrossRef | PubMed |
  12. Huang X, Zhang X, Wang F, Wei H, Ma H, Sui M, et al. Clinical Efficacy of Therapy with Recombinant Human Interferon α1b in Hand, Foot, and Mouth Disease with Enterovirus 71 Infection. PLoS One. 2016 Feb 16;11(2):e0148907. | CrossRef | PubMed |
  13. Damle D. Oral acyclovir for severe hand, foot and mouth disease. Indian J Drugs Dermatology. 2018 Jul 1;4(2):73-5. | Link |
  14. Bicknell L, Parekh P, Ramamurthi A. Atypical presentation of cutaneous hand-foot-mouth disease in an adult with rapid response to acyclovir. J Am Acad Dermatol [Internet]. 2015 May 1;72(5):AB139. | CrossRef |
  15. Shelley WB, Hashim M, Shelley ED. Acyclovir in the treatment of hand-foot-and-mouth disease. Cutis. 1996 Apr;57(4):232-4. | PubMed |
  16. Li X-W, Ni X, Qian S-Y, Wang Q, Jiang R-M, Xu W-B, et al. Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition). World J Pediatr. 2018 Oct;14(5):437-447. | CrossRef | PubMed |
  17. Zhang D, Chen J, Ba-Thein W. Hand-foot-mouth disease and use of steroids, intravenous immunoglobulin, and traditional Chinese herbs in a tertiary hospital in Shantou, China. BMC Complement Altern Med. 2018 Jun 20;18(1):190. | CrossRef | PubMed |
  18. Ye N, Gong X, Pang L, Gao W, Zhang Y, Li X, et al. Cytokine responses and correlations thereof with clinical profiles in children with enterovirus 71 infections. BMC Infect Dis. 2015 Jun 11;15:225. | CrossRef | PubMed |
  19. Zhu FC, Meng FY, Li JX, Li XL, Mao QY, Tao H, et al. Efficacy, safety, and immunology of an inactivated alum-adjuvant enterovirus 71 vaccine in children in China: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2013 Jun 8;381(9882):2024-32. | CrossRef | PubMed |
  20. Hu YM, Wang X, Wang JZ, Wang L, Zhang YJ, Chang L, et al. Immunogenicity, safety, and lot consistency of a novel inactivated enterovirus 71 vaccine in Chinese children aged 6 to 59 months. Clin Vaccine Immunol. 2013 Dec;20(12):1805-11. | CrossRef | PubMed |
  21. Rodríguez-Zúñiga MJM, Vértiz-Gárate K, Cortéz-Franco F, Qujiano-Gomero E. [Hand, foot, and mouth disease in a hospital in Callao in 2016]. Rev Peru Med Exp Salud Publica. 2017 Jan-Mar;34(1):132-138. | CrossRef | PubMed |
  22. Shin JU, Oh SH, Lee JH. A Case of Hand-foot-mouth Disease in an Immunocompetent Adult. Ann Dermatol. 2010 May;22(2):216-8. | CrossRef | PubMed |
  23. Chan LG, Parashar UD, Lye MS, Ong FG, Zaki SR, Alexander JP, Ho KK, et al. Deaths of children during an outbreak of hand, foot, and mouth disease in sarawak, malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group. Clin Infect Dis. 2000 Sep;31(3):678-83. Epub 2000 Oct 4. | PubMed |
Zeng H, Lu J, Zheng H, Yi L, Guo X, Liu L, et al. The Epidemiological Study of Coxsackievirus A6 revealing Hand, Foot and Mouth Disease Epidemic patterns in Guangdong, China. Sci Rep. 2015 May 21;5:10550. | CrossRef | PubMed |

Stewart CL, Chu EY, Introcaso CE, Schaffer A, James WD. Coxsackievirus A6-induced hand-foot-mouth disease. JAMA Dermatol. 2013 Dec;149(12):1419-21. | CrossRef | PubMed |

Cisterna DM, Lema CL, Martinez LM, Verón E, Contarino LP, Acosta D, et al. Atypical hand, foot, and mouth disease caused by Coxsackievirus A6 in Argentina in 2015. Rev Argent Microbiol. 2019 Apr - Jun;51(2):140-143. | CrossRef | PubMed |

Larralde M, Aristizábap AM. Enfermedad mano-pie-boca. Arch Argent Dermatol. 2005;25-9. | Link |

Cabrera D, Anet E, Plasencia R, Espinosa L. Enfermedad boca mano pie . Presentación de un caso Foot , hand and mouth disease . Case presentation. Medisur. 2018;469-74. | Link |

Koh WM, Badaruddin H, La H, Chen MI, Cook AR. Severity and burden of hand, foot and mouth disease in Asia: a modelling study. BMJ Glob Health. 2018 Jan 26;3(1):e000442. | CrossRef | PubMed |

Martines, Virginia; Laureano M. Enfermedad mano-pie-boca. Presentación de un caso y breve revisión de la literatura. Rev Cent Dermatol Pascua. 1999;8:21-4. | Link |

Bennesch M, Fernández P, Salvaneschi B. Enfermedad mano-pie-boca del adulto, emergencia del Coxsackie A6. Dermatología Argentina. 2017;23:183-7. | Link |

Silvente C, Valdivielso M, Hernanz JM. Enfermedad mano-pie-boca. 2010;68(2):85-7. | Link |

Sasaki O, Karaki T, Imanishi J. Protective effect of interferon on infections with hand, foot, and mouth disease virus in newborn mice. J Infect Dis. 1986 Mar;153(3):498-502. | PubMed |

Lin H, Huang L, Zhou J, Lin K, Wang H, Xue X, et al. Efficacy and safety of interferon-α2b spray in the treatment of hand, foot, and mouth disease: a multicenter, randomized, double-blind trial. Arch Virol. 2016 Nov;161(11):3073-80. | CrossRef | PubMed |

Huang X, Zhang X, Wang F, Wei H, Ma H, Sui M, et al. Clinical Efficacy of Therapy with Recombinant Human Interferon α1b in Hand, Foot, and Mouth Disease with Enterovirus 71 Infection. PLoS One. 2016 Feb 16;11(2):e0148907. | CrossRef | PubMed |

Damle D. Oral acyclovir for severe hand, foot and mouth disease. Indian J Drugs Dermatology. 2018 Jul 1;4(2):73-5. | Link |

Bicknell L, Parekh P, Ramamurthi A. Atypical presentation of cutaneous hand-foot-mouth disease in an adult with rapid response to acyclovir. J Am Acad Dermatol [Internet]. 2015 May 1;72(5):AB139. | CrossRef |

Shelley WB, Hashim M, Shelley ED. Acyclovir in the treatment of hand-foot-and-mouth disease. Cutis. 1996 Apr;57(4):232-4. | PubMed |

Li X-W, Ni X, Qian S-Y, Wang Q, Jiang R-M, Xu W-B, et al. Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition). World J Pediatr. 2018 Oct;14(5):437-447. | CrossRef | PubMed |

Zhang D, Chen J, Ba-Thein W. Hand-foot-mouth disease and use of steroids, intravenous immunoglobulin, and traditional Chinese herbs in a tertiary hospital in Shantou, China. BMC Complement Altern Med. 2018 Jun 20;18(1):190. | CrossRef | PubMed |

Ye N, Gong X, Pang L, Gao W, Zhang Y, Li X, et al. Cytokine responses and correlations thereof with clinical profiles in children with enterovirus 71 infections. BMC Infect Dis. 2015 Jun 11;15:225. | CrossRef | PubMed |

Zhu FC, Meng FY, Li JX, Li XL, Mao QY, Tao H, et al. Efficacy, safety, and immunology of an inactivated alum-adjuvant enterovirus 71 vaccine in children in China: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2013 Jun 8;381(9882):2024-32. | CrossRef | PubMed |

Hu YM, Wang X, Wang JZ, Wang L, Zhang YJ, Chang L, et al. Immunogenicity, safety, and lot consistency of a novel inactivated enterovirus 71 vaccine in Chinese children aged 6 to 59 months. Clin Vaccine Immunol. 2013 Dec;20(12):1805-11. | CrossRef | PubMed |

Rodríguez-Zúñiga MJM, Vértiz-Gárate K, Cortéz-Franco F, Qujiano-Gomero E. [Hand, foot, and mouth disease in a hospital in Callao in 2016]. Rev Peru Med Exp Salud Publica. 2017 Jan-Mar;34(1):132-138. | CrossRef | PubMed |

Shin JU, Oh SH, Lee JH. A Case of Hand-foot-mouth Disease in an Immunocompetent Adult. Ann Dermatol. 2010 May;22(2):216-8. | CrossRef | PubMed |

Chan LG, Parashar UD, Lye MS, Ong FG, Zaki SR, Alexander JP, Ho KK, et al. Deaths of children during an outbreak of hand, foot, and mouth disease in sarawak, malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group. Clin Infect Dis. 2000 Sep;31(3):678-83. Epub 2000 Oct 4. | PubMed |