Unusual skin manifestation of hand, foot and mouth disease associated with coxsackievirus A6: cases report

Background: Hand, food, and mouth disease (HFMD) is a highly contagious disease caused by enteroviruses infection. It is a health problem in young children under 5 years of age worldwide. The common causative agents are coxsackievirus A 16 (CA16) and enterovirus 71 (EV71). In recent years, coxsackievirus A6 (CA6) has emerged to be one of the major etiologic agents of HFMD worldwide including in Thailand. Case description: We reported cases with unusual skin manifestations of CA6-associated HFMD such as widespread severe cutaneous eruption, large vesicles (varicelliform), purpuric-like lesions or Gianotti-Crosti like eruptions. Discussion and evaluation: Molecular characterization of the CA6 strains from those patients found that all were clustered in the same group of CA6 that are currently circulating in Thailand. Conclusions: Clinicians need to be aware of the expanded range of cutaneous findings in CA6-associated HFMD in order to properly consider the diagnosis, management and prevention.