{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T16:26:17Z","timestamp":1770740777690,"version":"3.49.0"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2016,8,26]],"date-time":"2016-08-26T00:00:00Z","timestamp":1472169600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cutan Pathol"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Hand, foot, and mouth disease (<jats:styled-content style=\"fixed-case\">HFMD<\/jats:styled-content>) is a contagious illness most commonly occurring in children 5 years old or younger. The most common cause of <jats:styled-content style=\"fixed-case\">HFMD<\/jats:styled-content> in the United States is Coxsackievirus <jats:styled-content style=\"fixed-case\">A16<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">HFMD<\/jats:styled-content> is uncommon in adults, and may show other atypical features including a broader spectrum of cutaneous involvement and a greater degree of severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated the clinical, histopathologic and molecular features of three cases of atypical <jats:styled-content style=\"fixed-case\">HFMD<\/jats:styled-content> occurring in adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All three cases showed clinical features that were worrisome for erythema multiforme or a disseminated herpesvirus infection. The histopathologic findings were quite uniform, and showed intraepidermal vesiculation with a predominantly neutrophil\u2010rich infiltrate. A characteristic feature was the specific involvement of the upper stratum spinosum and stratum granulosum, with relative sparing of the stratum corneum. In none of the cases was there evidence of herpesvirus. Molecular analysis performed on two of the cases showed involvement by Coxsackievirus <jats:styled-content style=\"fixed-case\">A6<\/jats:styled-content>, an uncommon serotype in <jats:styled-content style=\"fixed-case\">HFMD<\/jats:styled-content>. All three cases resolved spontaneously.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Atypical HFMD associated with Coxsackievirus <jats:styled-content style=\"fixed-case\">A6<\/jats:styled-content> represents an uncommon and potentially diagnostically challenging cutaneous eruption. Its recognition is critical to avoid unneeded therapy and to establish accurate prognostic expectations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cup.12775","type":"journal-article","created":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T12:27:19Z","timestamp":1469190439000},"page":"940-945","source":"Crossref","is-referenced-by-count":33,"title":["Atypical hand, foot and mouth disease in adults associated with coxsackievirus <scp>A6<\/scp>: a clinico\u2010pathologic study"],"prefix":"10.1111","volume":"43","author":[{"given":"Alvaro C.","family":"Laga","sequence":"first","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne M.","family":"Shroba","sequence":"additional","affiliation":[{"name":"Department of Dermatology Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Hanna","sequence":"additional","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,8,26]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268809991555"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clindermatol.2014.12.011"},{"key":"e_1_2_5_4_1","first-page":"1","article-title":"Enterovirus surveillance \u2010 United States, 1970\u20132005","volume":"55","author":"Khetsuriani N","year":"2006","journal-title":"MMWR Surveill Summ"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2016.00391"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2013.07.024"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1810.120813"},{"key":"e_1_2_5_8_1","first-page":"213","article-title":"Notes from the field: severe hand, foot and mouth disease associated with coxsackievirus A6 \u2010\u2010 Alabama, Connecticut, California, and Nevada, november of 2011\u2013february 2012","volume":"61","author":"Mcintyre MG","year":"2012","journal-title":"MMWR"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70264-0"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-346"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-3175"},{"key":"e_1_2_5_12_1","first-page":"465","volume-title":"Mucocutaneous manifestations of viral diseases","author":"Galen WK","year":"2002"},{"key":"e_1_2_5_13_1","first-page":"615","article-title":"Report of an outbreak of febrile illness with pharyngeal lesions and exanthem: Toronto, summer 1957 isolation of group A coxsackie virus","volume":"79","author":"Robinson CR","year":"1958","journal-title":"Can Med Assoc J"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.1967.tb11500.x"},{"key":"e_1_2_5_15_1","first-page":"637","article-title":"Hand, foot and mouth syndrome. Report of six cases due to coxsackie virus, group A, type 16","volume":"37","author":"Cherry JD","year":"1966","journal-title":"Pediatrics"},{"key":"e_1_2_5_16_1","first-page":"278","article-title":"Hand, foot and mouth disease (Coxsackie virus A 16) in Atlanta","volume":"114","author":"Froeschle JE","year":"1967","journal-title":"Am J Dis Child"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1968.03140100009002"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00584517"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.122.237"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1509.090438"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2013.6777"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/path.4438"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jit383"}],"container-title":["Journal of Cutaneous Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcup.12775","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cup.12775","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T21:14:04Z","timestamp":1696367644000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cup.12775"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8,26]]},"references-count":22,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2016,11]]}},"alternative-id":["10.1111\/cup.12775"],"URL":"https:\/\/doi.org\/10.1111\/cup.12775","archive":["Portico"],"relation":{},"ISSN":["0303-6987","1600-0560"],"issn-type":[{"value":"0303-6987","type":"print"},{"value":"1600-0560","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8,26]]}}}