Not only fever and palmoplantar vesicular eruption

Excerpt

Nail matrix arrest is commonly seen following a physiological stress, nutritional deficiencies, drug/chemotherapeutic exposures, infection, and systemic illnesses [1] such as hand-foot-mouth disease (HFMD). Here, we describe a case of onychomadesis due to HFMD. A 20-year-old girl, with past medical history unremarkable (no drug-, no prior trauma-, no paronychia, no onychomycosis-history was reported), presented with fever, sore throat, and palmoplantar vesicular eruption consistent with the diagnosis of HFMD, which had since resolve. However 3 weeks later, clinical examination revealed Beau’s lines (transverse ridging of the nail plate) and onychomadesis over all the finger- and some of toe-nails. HFMD is a common benign self-limiting childhood viral illness associated with coxsackievirus A16 (CV-A16) and enterovirus 71 (EV-71) infections [2]. Atypical HFMD is a possible cause of onychomadesis (growth cessation of longer-term nail and/or nail matrix causes nail shedding from the proximal portion) [3]. The incidence of this phenomenon was not reported [4]. It was first described in 2000 in five children, and it has since been associated to several enterovirus serotypes, especially CV-A16 [3]. The underlying mechanisms is still unclear. Davia et al. proposed that the virus, through direct action on the nail matrix keratinocytes, would probably lead to arrest it [1]. The temporal association, with 3–9 weeks interval, between disease and nail injury suggestes the causal relationship [1, 3, 4]. Complete nail regrowth is typically 1–4 months later [1]. Here, we would want to highlight some new aspects of an old disease and to emphasize the importance of an accurate differential diagnosis. (Figs. 1, 2 and 3).

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