Forme atipiche di malattia mani-piedi-bocca: La nostra esperienza

Background: Hand, foot, and mouth disease is a pediatric infectious illness caused by enteroviruses, mainly Coxsackivirus A16 and Enterovirus 71 serotypes. Since 2008, an outbreak caused by Coxsackievirus A6 was reported, with high fever and different cutaneous findings such as small vesicles evolving into vesicular-bullous lesions or bullae. Moreover, lesions tend to appear on eczematous areas in children affected by atopic dermatitis. We have set this observational, prospectic study in order to describe the clinical aspects of the atypical forms of hand, foot and mouth disease. Methods: Patients affected by atypical forms of hand, foot, and mouth disease consecutively seen at the Pediatric Dematology Outpatients' Service of S.Orsola-Malpighi Hospital in Bologna from January 2012 and February 2014 were enrolled. The distribution, typology and extension of the lesions were evaluated. In some patients, viral genotyping was also performed. Results: 47 patients were enrolled with a median age of 22 months. We identified 3 main clinical aspects: 1) acral form (predominantly acral distribution of the lesions) in 62% of the patients; 2) eczema coxsackium (lesions distributed on eczematous areas) in 23% of the patients; 3) widespread form (lesions involving also the trunk) in 15% of the patients. Around 80% of the patients had acral purpuric macules (moderate or severe in 40%), up to 70% had a non-classical moderate or severe vesicular eruption. Around half of the subjects had purpuric lesions and 72% buttocks involvement. In 9 out of 11 genotyped patients, Coxsackievirus A6 was identified. Conclusions: With the present study, we were able to describe 3 phenotypes of the atypical hand, foot, and mouth disease, in order to correctly identify this illness and distinguish it from varicella, eczema herpeticum, vasculitis, impetigo and set up a proper management.