Adult Hand,Foot,and Mouth Disease

A 40-year-old male visited to our outpatient department presenting with mild fever, general malaise, irritated tongue, and odynophagia for 3 days. Tracing his contact history, his 5-year-old child had similar symptoms and was treated under the diagnosis of hand, foot, and mouth disease (HFMD) in local clinic 1 week before the father’s illness started. On physical examination, multiple maculopapular lesions involved his ventral surface of fingers, palm (Figure 1A), and the lateral border of the feet (Figure 1B). Numerous whitish-yellow vesicular lesions involved the soft palate and lower lip, and swollen and strawberry-like tongue was discovered (Figure 1C). He was diagnosed with HFMD. The patient was managed with supportive treatment and educated to maintain hygiene. Three days later, his symptoms resolved, and a part of maculopapular lesions developed into blisters following by palmoplantar desquamation (Figure 1D).

Figure 1.

A, Multiple maculopapular lesions with diameters ranging from 1 to 10 mm on the ventral surface of the fingers and palms. B, Maculopapular lesions also involved the lateral border of the feet, soles, and heels. C, Right, Numerous whitish-yellow vesicular lesions surrounded by an erythematous rim involving the soft palate, anterior faucial pillar, and lower lip. C, Right, The tongue presented with a swollen dorsal surface and reddish papillae of strawberry-like appearance. D, Maculopapular lesions on the palms and soles developed into blisters followed by palmoplantar desquamation 3 days later.

Hand-foot-and-mouth disease caused by Coxsackie virus, echovirus, and enterovirus usually is diagnosed clinically based on the typical appearance of exanthema located on the oral mucosa or skin. Hand, foot, and mouth disease is generally self-limited. Although HFMD is more common in infants and children than in adults, an increased number of cases of HFMD among adult has been observed recently. This could be caused by climate change, the global travel boom, and continued viral gene mutation. ¹ In some observational studies, atypical clinical manifestations such as presenting with strawberry tongue instead of prominent vesicular oral lesions are common in adult patients and may lead to misdiagnosis. ² When the clinical clues remain uncertain, collecting samples for cell cultures or nucleic acid amplification from the throat, stool, and vesicular fluid can establish the diagnosis. ³

Although HFMD still is most common in infants and children, our case highlights that clinicians be aware of the increasing incidence of HFMD in adults. Recognizing the entity early is important to help prevent and recognize early uncommon but potentially severe complications including meningitis, encephalitis, and myocarditis. ^{1 -3}