Acute localized exanthem due to Coxsackievirus A4

Area of Science:

• Virology
• Dermatology
• Infectious Diseases

Background:

• Enteroviruses are common causes of childhood exanthems, often occurring in summer and autumn.
• Infections can manifest as epidemics or smaller outbreaks.
• Physicians should consider viral causes for skin eruptions.

Purpose of the Study:

• To report a rare case of localized exanthem in an adult caused by Coxsackievirus A4.
• To highlight the diagnostic considerations for unusual viral skin manifestations.

Main Methods:

• Case report of a 30-year-old woman with a localized rash.
• Serological testing for IgM and IgG antibodies against Coxsackievirus A4.
• Molecular detection of enterovirus RNA using reverse transcriptase real-time PCR in plasma and faeces.

Main Results:

• A localized erythematous maculopapular rash with petechiae was observed exclusively under the right nipple.
• The rash was accompanied by an enanthem, fever, headache, asthenia, sore throat, and arthralgias.
• Coxsackievirus A4 infection was confirmed serologically and by PCR detection of viral RNA.

Conclusions:

• Enteroviruses, specifically Coxsackievirus A4, can cause localized exanthems in adults.
• Physicians should consider enteroviral infections in the differential diagnosis of localized dermatitis, especially with systemic symptoms and enanthems.
• This case expands the known spectrum of enterovirus-induced skin manifestations beyond typical hand-foot-mouth disease.