HAND-foot-and-mouth disease occurs almost exclusively in children and is usually benign and self-limited. It is caused primarily by coxsackievirus A16,1 although coxsackieviruses A5, A9, and A10 have also been implicated.2,3 We recently treated a woman who had classic hand-foot-and-mouth disease, which then progressed to pancarditis and fatal pneumonia. The causative agent was coxsackievirus A7.
Report of a Case
A 29-year-old woman was admitted to the Medical Center Hospital of Vermont with fever, a maculopapular rash on her arms and legs, a sore throat with small vesicles on the pharynx, vesicles on the vaginal mucosa, and abdominal pain. Her illness had begun two days earlier, with pleuritic discomfort exacerbated by deep breathing. The next day a papular rash appeared on her arms and legs. The pleuritic pain worsened, she became febrile, and she noted conjunctival redness. The papular rash had progressed, becoming papulovesicular and involving her thighs, hands, and