PMC5292754_01
Atypical HFMD. Pink edematous papules and vesicles on erythematous bases to the dorsal hands and fingers. Macerated plaques in the interdigital spaces.
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His vesicular eruption involved the scalp, face, axillae, antecubital fossae, inguinal folds, penis, scrotum, buttocks, and dorsal hands (Fig 1).
Eczema coxsackium. Background erythema and scaling in the antecubital fossa with overlying erythematous edematous papules, vesicles, and erosions.
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Notably, his eruption developed within sites at which he had known chronic GVHD (Fig 2).
Coxsackievirus infection. Superficially necrotic epidermis with a papillary to mid-dermal inflammatory infiltrate. (Hematoxylin-eosin stain.)
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Within the dermis, there was a superficial to mid-dermal predominantly perivascular infiltrate composed of lymphocytes, histiocytes, and plasma cells along with rare eosinophils (Figs 3 and 4).
Coxsackievirus infection. Neutrophils present within the necrotic upper epidermis overlying scattered necrotic keratinocytes with associated lymphocytic vacuolar interface dermatitis. (Hematoxylin-eosin stain.)
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Within the dermis, there was a superficial to mid-dermal predominantly perivascular infiltrate composed of lymphocytes, histiocytes, and plasma cells along with rare eosinophils (Figs 3 and 4).