Acta Dermato-Venereologica 98-7CompleteContent | Page 25

718 CORRESPONDENCE Hand, Foot and Mouth Disease and Echovirus 3: A Comment to Høgsberg & Bygum Pascal DEL GIUDICE and Thomas HUBICHE Dermatology and Infectious Diseases Unit, Centre Hospitalier de Fréjus-Saint-Raphël, 240 avenue Saint Lambert, FR-83600 Fréjus, France. E-mail: [email protected] We read with great interest the case report by Høgsberg & Bygum (1) of atypical hand, foot and mouth (HFM) disease caused by echovirus 3; however, we do not share their conclusion. The finding of an enterovirus, such as echovirus 3, in stools can be incidental. Indeed, enterovi- ruses can be excreted in stools for 10 weeks or more after an infection (2). Therefore the finding of an enterovirus in stools is not sufficiently specific to draw a definitive conclusion of causality in HFM. This is even more the case if the enterovirus isolated is not considered a usual pathogen associated with HFM. The virus is present in skin vesicle fluid (3), therefore the most specific virologi- cal test in HFM is the sampling of the contents of skin vesicles using enterovirus PCR to confirm the causal link. Reply to the Comment by Del Giudice & Hubiche Trine HØGSBERG and Anette BYGUM Department of Dermatology, Odense University Hospital, Søndre Blvd 29, DK-5000 Odense C, Denmark. E-mail: [email protected]. We appreciate the comment from Del Giudice & Hubi- che. We share the point that the detection of echovirus 3 may be purely incidental. However, the patient presented a clinical picture compatible  with atypical hand, foot, and mouth disease, and no other differential diagnoses fitted appropriately. A skin swab was negative for herpes- virus, varicella zoster virus, enterovirus and pathogenic bacteria. Echovirus 3 was detected in stool. The finding of echovirus 3 has been reported previously in a patient with hand, foot, and mouth associated onychomadesis (4), but could also be seen in controls. We must conclude that we found a temporal relationship of echovirus 3 and atypical hand, foot, and mouth disease, but cannot prove a causal relationship. REFERENCES (for both papers) 1. Høgsberg T, Bygum A. Disseminated vesicular rash in an im- munocompetent adult woman: a quiz. atypical hand, foot, and mouth disease caused by echovirus 3. Acta Derm Ve- nereol 2018; 98: 163–164. 2. Chung PW, Huang YC, Chang LY, Lin TY, Ning HC. Duration of enterovirus shedding in stool. I Microbiol Immune Infect 2001; 34: 167–170. 3. Hubiche  T, Schuffenecker I, Boralevi F, Léauté-Labrèze C, doi: 10.2340/00015555-2943 Acta Derm Venereol 2018; 98: 718 Bornebusch L, Chiaverini C, et al. Dermatological spectrum of hand, foot and mouth disease from classical to generalized exanthema. Pediatr Infect Dis J 2014; 33: e92–e98. 4. Davia JL, Bel PH, Ninet VZ, Bracho MA, González-Candelas F, Salazar A, et al. Onychomadesis outbreak in Valencia, Spain associated with hand, foot, and mouth disease caused by enteroviruses. Pediatr Dermatol 2011; 28: 1–5. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica.