Eczema coxsackium and unusual cutaneous findings in an enterovirus outbreak

Erin F. Mathes, Vikash Oza, Ilona J. Frieden, Kelly M. Cordoro, Shigeo Yagi, Renee Howard, Leonard Kristal, Christine C. Ginocchio, Julie Schaffer, Sheilagh Maguiness, Susan Bayliss, Irene Lara-Corrales, Maria Teresa Garcia-Romero, Dan Kelly, Maria Salas, M. Steven Oberste, Allan Nix, CarolGlaser, Richard Antaya

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)-associated North American enterovirus outbreak of 2011-2012. METHODS: We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. RESULTS: Eighty patients were included in this study (median age 1.5 years, range 4 months-16 years). Seventeen patients were CVA6- positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving >10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed 'eczema coxsackium.' Other morphologies included Gianotti-Crosti-like (37%), petechial/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. CONCLUSIONS: The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease. Pediatrics 2013;132:e149-e157.

Original languageEnglish (US)
JournalPediatrics
Volume132
Issue number1
DOIs
StatePublished - Jul 1 2013

Fingerprint

Enterovirus
Eczema
Hand, Foot and Mouth Disease
Disease Outbreaks
Exanthema
Skin
Pediatrics
Kaposi Varicelliform Eruption
Impetigo
Buttocks
Body Surface Area
Vasculitis
Dermatology
Routine Diagnostic Tests
Extremities
Demography

Keywords

  • And mouth disease
  • Atopic dermatitis
  • Coxsackievirus
  • Exanthem
  • Foot
  • Hand

Cite this

Mathes, E. F., Oza, V., Frieden, I. J., Cordoro, K. M., Yagi, S., Howard, R., ... Antaya, R. (2013). Eczema coxsackium and unusual cutaneous findings in an enterovirus outbreak. Pediatrics, 132(1). https://doi.org/10.1542/peds.2012-3175

Eczema coxsackium and unusual cutaneous findings in an enterovirus outbreak. / Mathes, Erin F.; Oza, Vikash; Frieden, Ilona J.; Cordoro, Kelly M.; Yagi, Shigeo; Howard, Renee; Kristal, Leonard; Ginocchio, Christine C.; Schaffer, Julie; Maguiness, Sheilagh; Bayliss, Susan; Lara-Corrales, Irene; Garcia-Romero, Maria Teresa; Kelly, Dan; Salas, Maria; Oberste, M. Steven; Nix, Allan; CarolGlaser; Antaya, Richard.

In: Pediatrics, Vol. 132, No. 1, 01.07.2013.

Research output: Contribution to journalArticle

Mathes, EF, Oza, V, Frieden, IJ, Cordoro, KM, Yagi, S, Howard, R, Kristal, L, Ginocchio, CC, Schaffer, J, Maguiness, S, Bayliss, S, Lara-Corrales, I, Garcia-Romero, MT, Kelly, D, Salas, M, Oberste, MS, Nix, A, CarolGlaser & Antaya, R 2013, 'Eczema coxsackium and unusual cutaneous findings in an enterovirus outbreak', Pediatrics, vol. 132, no. 1. https://doi.org/10.1542/peds.2012-3175
Mathes EF, Oza V, Frieden IJ, Cordoro KM, Yagi S, Howard R et al. Eczema coxsackium and unusual cutaneous findings in an enterovirus outbreak. Pediatrics. 2013 Jul 1;132(1). https://doi.org/10.1542/peds.2012-3175
Mathes, Erin F. ; Oza, Vikash ; Frieden, Ilona J. ; Cordoro, Kelly M. ; Yagi, Shigeo ; Howard, Renee ; Kristal, Leonard ; Ginocchio, Christine C. ; Schaffer, Julie ; Maguiness, Sheilagh ; Bayliss, Susan ; Lara-Corrales, Irene ; Garcia-Romero, Maria Teresa ; Kelly, Dan ; Salas, Maria ; Oberste, M. Steven ; Nix, Allan ; CarolGlaser ; Antaya, Richard. / Eczema coxsackium and unusual cutaneous findings in an enterovirus outbreak. In: Pediatrics. 2013 ; Vol. 132, No. 1.
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abstract = "OBJECTIVE: To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)-associated North American enterovirus outbreak of 2011-2012. METHODS: We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. RESULTS: Eighty patients were included in this study (median age 1.5 years, range 4 months-16 years). Seventeen patients were CVA6- positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61{\%} of patients had rash involving >10{\%} body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55{\%} of patients, the eruption was accentuated in areas of eczematous dermatitis, termed 'eczema coxsackium.' Other morphologies included Gianotti-Crosti-like (37{\%}), petechial/purpuric (17{\%}) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. CONCLUSIONS: The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease. Pediatrics 2013;132:e149-e157.",
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AU - Mathes, Erin F.

AU - Oza, Vikash

AU - Frieden, Ilona J.

AU - Cordoro, Kelly M.

AU - Yagi, Shigeo

AU - Howard, Renee

AU - Kristal, Leonard

AU - Ginocchio, Christine C.

AU - Schaffer, Julie

AU - Maguiness, Sheilagh

AU - Bayliss, Susan

AU - Lara-Corrales, Irene

AU - Garcia-Romero, Maria Teresa

AU - Kelly, Dan

AU - Salas, Maria

AU - Oberste, M. Steven

AU - Nix, Allan

AU - CarolGlaser,

AU - Antaya, Richard

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N2 - OBJECTIVE: To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)-associated North American enterovirus outbreak of 2011-2012. METHODS: We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. RESULTS: Eighty patients were included in this study (median age 1.5 years, range 4 months-16 years). Seventeen patients were CVA6- positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving >10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed 'eczema coxsackium.' Other morphologies included Gianotti-Crosti-like (37%), petechial/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. CONCLUSIONS: The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease. Pediatrics 2013;132:e149-e157.

AB - OBJECTIVE: To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)-associated North American enterovirus outbreak of 2011-2012. METHODS: We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. RESULTS: Eighty patients were included in this study (median age 1.5 years, range 4 months-16 years). Seventeen patients were CVA6- positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving >10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed 'eczema coxsackium.' Other morphologies included Gianotti-Crosti-like (37%), petechial/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. CONCLUSIONS: The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease. Pediatrics 2013;132:e149-e157.

KW - And mouth disease

KW - Atopic dermatitis

KW - Coxsackievirus

KW - Exanthem

KW - Foot

KW - Hand

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