Gender
|
Male |
Male |
Male |
Age (years)
|
33 |
39 |
21 |
Epidemiological Background
|
- |
Daughter with HFMD, 1 week before |
- |
Skin Lesions
|
Oral enanthema and painful maculopapular rash |
Multiple purpuric macules and papules, itchy and isolated blisters |
Oral enanthema and oral ulcers, multiple erythematous papules, and itchy and painful blisters |
Location of Skin Lesions
|
Scalp, face, chest, hands, and feet (Fig. 1) |
Scalp, face, auricular pavilions, hands, thighs, and feet (Fig. 2) |
Oral mucosa, back of the tongue, and hard palate. Armpits, elbows, hands, and feet (Fig. 3) |
Systemic Symptoms
|
Fever, odynophagia, and general malaise |
Fever, myalgia, and bilateral orchitis |
Odynophagia |
Presumptive Diagnosis
|
Syphilis and HFMD |
Syphilis, HFMD, and blistering diseases |
Syphilis, HFMD, milker's nodules, blistering diseases, and Kaposi's chickenpox-like rash |
Laboratory
|
No changes |
Leukocytosis (12000/mm3) |
Leukocytosis (13100/mm3) |
Serologies
|
VDRL and HIV non-reactive |
HCV, HBV, VDRL, HIV, CMV, EBV, and Parvovirus non-reactive |
HCV, HBV, VDRL, HIV, CMV, EBV, HSV, HZV, Mycoplasma, and Parvovirus non-reactive. |
IgM for Coxsackie virus B1-B6 reactive |
IgM for Coxsackie virus B1-B6 reactive |
IgG for Coxsackie virus with 4× titer increase 15 days later |
Skin Biopsy
|
- |
Compatible with viral infection, probable HFMD (Fig. 4) |
Compatible with viral infection, probable HFMD |
Diagnosis
|
Serological |
Serological and histological |
Serological and histological |
Treatment
|
NSAIDS |
NSAIDS and wet treatments of denuded blisters |
NSAIDS and gargles with lidocaine |
Clinical Progress
|
Resolution in 10 days |
Resolution in 15 days |
Resolution in 20 days |
Complications
|
- |
Onycholysis on hands and feet (2 months later) |
- |