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

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.1 However, there are increasing reports of atypical presentations caused by other viral serotypes, most commonly coxsackievirus A6 (CVA6).2 Mathes et al3 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-Crosti–like eruption of vesicles and edematous papules in an acrofacial distribution, and petechial/purpuric papulovesicles on the palms and soles.