[Hand-foot-mouth disease with atypical clinical presentation caused by Coxsackievirus A6]

Hand-foot-mouth disease is typically a mild, self-limiting enterovirus infection, most often caused by Coxsackievirus A16 and enterovirus A71. Over the past 15 years, however, Coxsackievirus A6 (CVA6) has emerged worldwide, including in Hungary, as the main pathogen responsible for atypical clinical forms. Atypical hand-foot-mouth disease differs from the classic presentation by widespread vesiculobullous and often painful skin eruptions, frequent perioral lesions and post-infectious nail changes. We present the case of a 2-year-old girl with generalized vesicobullous eruptions, in whom CVA6 (clade D3a) infection was confirmed by RT-PCR and Sanger sequencing methods. After initial resolution, a recurrence of skin lesions occurred, followed six weeks later by nail shedding, which healed without sequelae. Diagnosis relies on the knowledge of the atypical clinical presentation, molecular-based detection, most reliably performed from vesicle fluid, stool, or oropharyngeal samples. Recognizing atypical clinical form of hand-foot-mouth disease is crucial, as its clinical manifestations may mimic other vesiculobullous diseases, potentially leading to unnecessary therapeutic interventions. Orv Hetil. 2026; 167(4): 156-161.