COXSACKIE VIRUS INFECTION, SEVERE
By Gary M. White, MD
Coxsackie virus (CSV) infection is classically associated with hand, foot, and mouth disease. Rarely, CSV can cause a more severe infection with larger vesicobullous lesions. This has been termed "Eczema coxsackium".
In a review of a large outbreak, the following was found:
- 88 patients, median age 1.5 (range 4 months to 16 years) Pediatrics. 2013 Jul;132:e149-57.
- 17 patients were coxsackievirus A6-positive
- There was a vesiculobullous and erosive eruption in nearly all (99%)
- 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
- See if your lab can do polymerase chain reaction testing.
- IV fluids if needed.
- Topical steroids may or may not be helpful
Courtesy O. Dale Collins, MD
Pediatrics. 2013 Jul;132:e149-57.
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