A case of eczema coxsackium with erythema multiforme–like histopathology in a 14-year-old boy with chronic graft-versus-host disease

CVA6: Coxsackievirus A6 CVA16: Coxsackievirus A16 EC: eczema coxsackium EV: enterovirus EM: erythema multiforme GVHD: graft-versus-host disease HFMD: hand, foot, and mouth disease HSV: herpes simplex virus RT-PCR: reverse transcriptase polymerase chain reaction SJS: Stevens-Johnson syndrome INTRODUCTION Hand, foot, and mouth disease (HFMD) is a common, self-limited viral exanthem characterized classically by mild fever, small vesicles/erosions of the oral mucosa, and painful oval, gray vesicles involving the palms, soles, buttocks, and genitalia of young children. Coxsackievirus A16 (CVA16) and enterovirus 71 are the most frequently implicated pathogens. However, there are increasing reports of atypical presentations caused by other viral serotypes, most commonly coxsackievirus A6 (CVA6). Mathes et al described 4 characteristic clinical morphologies of severe CVA6-associated atypical HFMD, including a widespread vesiculobullous eruption, localization of vesicles/erosions within areas of atopic dermatitis (eczema coxsackium [EC]), a Gianotti-Crostielike eruption of vesicles and edematous papules in an acrofacial distribution, and petechial/purpuric papulovesicles on the palms and soles. We report a case of EC presenting within lesions of chronic eczematous graft-versus-host disease (GVHD) with erythema multiforme (EM)/Stevens-Johnson syndrome (SJS)elike histopathology.