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By Brian J. Stairs, DO, and Stephen M. Schleicher, MD
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CASE:
A 14-year-old boy who says he has had a sore mouth for the past two days also complains of a slight fever, abdominal discomfort, and loss of appetite. His previous medical history is unremarkable. Examination of the oral cavity reveals erosive lesions on his tongue and palate. Also noted on his hands and feet are scattered, erythematous papulovesicles that are asymptomatic.
WHAT IS YOUR DIAGNOSIS?
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Hand-foot-and-mouth disease (HFMD) is an infectious disorder characterized by vesicular lesions occurring within the mouth and on the hands and feet. Most cases are caused by strains of coxsackie virus. Epidemics among school-aged children are not uncommon. Oral lesions rapidly progress from macules to vesicles that become erosive and painful. Associated findings may include fever, malaise, abdominal pain, and anorexia. Signs and symptoms resolve within seven days. The differential diagnosis of HFMD includes aphthous ulcers and herpes simplex virus. |
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Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Dr. Stairs is an associate with Westmoreland Dermatology in Greensburg, Pennsylvania.
Emerg Med 38(12):57-8, 2006
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