{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:09:16Z","timestamp":1790215756346,"version":"4.1.0"},"reference-count":22,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,6,3]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>A literature search confirmed no previous cases of necrotising fasciitis (NF) complicating hand,foot and mouth disease (HFMD). This report explores the case of a previously well 55-week-old Caucasian boy who attended accident and emergency with an acutely swollen right hand and atypical viral rash affecting the hands and face. He was admitted under plastic surgery and treated with intravenous antibiotics and fluid resuscitation for sepsis secondary to cellulitis. Following dermatological review of the rash, a clinical diagnosis of atypical HFMD was made. He deteriorated over the first 12\u2009hours with progression of cellulitis despite intervention. Emergency exploration and debridement were performed for suspected NF. NF was subsequently confirmed by laboratory testing. He required 5 days in paediatric intensive care but made a full recovery. Recent reports highlight an increase in atypical cases of HFMD. Clinicians should be aware of the potential for superadded necrotising infection in cases of atypical HFMD.<\/jats:p>","DOI":"10.1136\/bcr-2018-228581","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T05:59:20Z","timestamp":1566367160000},"page":"e228581","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Necrotising fasciitis complicating hand, foot and mouth disease"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2480-7012","authenticated-orcid":false,"given":"Clara","family":"Smith","sequence":"first","affiliation":[{"name":"Plastic Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Scott","sequence":"additional","affiliation":[{"name":"Canniesburn Plastic Surgery Unit, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,8,20]]},"reference":[{"issue":"1","key":"2025082706512615000_12.8.e228581.1","first-page":"4","article-title":"[Hand, foot and mouth disease--more than a harmless \"childhood disease\"]","volume":"37","author":"Stock","year":"2014","journal-title":"Med Monatsschr Pharm"},{"key":"2025082706512615000_12.8.e228581.2","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.clindermatol.2014.12.011","article-title":"Update on hand-foot-and-mouth disease","volume":"33","author":"Ventarola","year":"2015","journal-title":"Clin Dermatol"},{"key":"2025082706512615000_12.8.e228581.3","doi-asserted-by":"crossref","first-page":"515","DOI":"10.3109\/00365548.2014.907929","article-title":"Risk factors of severe hand, foot and mouth disease: a meta-analysis","volume":"46","author":"Fang","year":"2014","journal-title":"Scand J Infect Dis"},{"key":"2025082706512615000_12.8.e228581.4","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1111\/jpc.12708","article-title":"Outbreak of variant hand-foot-and-mouth disease caused by coxsackievirus A6 in Auckland, New Zealand","volume":"50","author":"Hayman","year":"2014","journal-title":"J Paediatr Child Health"},{"key":"2025082706512615000_12.8.e228581.5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-3175"},{"key":"2025082706512615000_12.8.e228581.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70342-6"},{"key":"2025082706512615000_12.8.e228581.7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/2751457","article-title":"The Risk Factors of Acquiring Severe Hand, Foot, and Mouth Disease: A Meta-Analysis","volume":"2018","author":"Sun","year":"2018","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"2025082706512615000_12.8.e228581.8","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70264-0"},{"key":"2025082706512615000_12.8.e228581.9","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s10096-018-3206-x","article-title":"Hand, foot and mouth disease: current knowledge on clinical manifestations, epidemiology, aetiology and prevention","volume":"37","author":"Esposito","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025082706512615000_12.8.e228581.10","doi-asserted-by":"publisher","DOI":"10.3201\/eid1509.090438"},{"key":"2025082706512615000_12.8.e228581.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2013.07.024"},{"key":"2025082706512615000_12.8.e228581.12","doi-asserted-by":"publisher","DOI":"10.3201\/eid1810.120813"},{"key":"2025082706512615000_12.8.e228581.13","first-page":"213","article-title":"Notes from the field: severe hand, foot, and mouth disease associated with coxsackievirus A6 - Alabama, Connecticut, California, and Nevada, November 2011-February 2012","volume":"61","author":"Centers for Disease Control and Prevention (CDC)","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025082706512615000_12.8.e228581.14","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00101-13"},{"key":"2025082706512615000_12.8.e228581.15","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3389\/fsurg.2017.00005","article-title":"Early Diagnosis and Surgical Treatment for Necrotizing Fasciitis: A Multicenter Study","volume":"4","author":"Misiakos","year":"2017","journal-title":"Front Surg"},{"key":"2025082706512615000_12.8.e228581.16","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.jpedsurg.2016.02.076","article-title":"Laboratory evaluation for pediatric patients with suspected necrotizing soft tissue infections: A case-control study","volume":"51","author":"Putnam","year":"2016","journal-title":"J Pediatr Surg"},{"key":"2025082706512615000_12.8.e228581.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9260(96)80164-4"},{"key":"2025082706512615000_12.8.e228581.18","doi-asserted-by":"crossref","DOI":"10.1148\/radiology.192.2.8029421","article-title":"MR imaging in acute infectious cellulitis","volume":"192","author":"Rahmouni","year":"1994","journal-title":"Radiology"},{"key":"2025082706512615000_12.8.e228581.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0720-048X(00)00164-9"},{"key":"2025082706512615000_12.8.e228581.20","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-pathol-121808-102135"},{"key":"2025082706512615000_12.8.e228581.21","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.6.1679"},{"key":"2025082706512615000_12.8.e228581.22","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00628-08"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228581","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T13:51:36Z","timestamp":1756302696000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228581"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":22,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8,20]]},"published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1136\/bcr-2018-228581"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228581","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}