Hand-foot-mouth disease in the elderly: A case report
Abstract
Hand-foot-mouth disease (HFMD), commonly caused by Coxsackievirus A16, is a contagious illness characterized by fever and vesicles on the hands, feet, and oral cavities. While well-documented in children, it is exceptionally rare in older adults. The case of a 65-year-old. illustrates this. woman who presented at Dr. Sardjito General Hospital, Yogyakarta, with red spots on her hands and feet. Examination revealed multiple erythematous plaques on her palms, forearms, and lower legs, alongside target-like plaques with pseudo-vesiculation and a solitary oral ulcer. This case underscores the unusual presentation of HFMD in the elderly, highlighting that the disease, though predominantly pediatric, can occur in the elderly. The atypical clinical findings highlight the urgent need for accurate and timely recognition to ensure appropriate management. This report contributes to the growing evidence on HFMD’s clinical spectrum in adults and signals the necessity for further research and case documentation to improve understanding and early diagnosis in the elderly population.
References
Zhu P, Ji W, Li D, Li Z, Chen Y, Dai B, et al. Current status of hand-foot-and- mouth disease. J Biomed Sci 2023; 30(1):15.
https://doi.org/10.1186/s12929-023- 00908-4
Yi Z, Pei S, Suo W, Wang X, Huang Z, Yi A, et al. Epidemiological characteristics, routine laboratory diagnosis, clinical signs and risk factors for hand, -foot -and -mouth disease: A systematic review and meta-analysis. PLoS One 2022; 17(4):e0267716.
https://doi.org/10.1371/journal. pone.0267716
Yan R, He J, Liu G, Zhong J, Xu J, Zheng K, et al. Drug repositioning for hand, foot, and mouth disease. Viruses 2022; 15(1):75.
https://doi.org/10.3390/v15010075
Kimmis B, Downing C, Tyring S. Hand-foot-and-mouth disease caused by coxsackievirus A6 on the rise. New York, NY: Cutis, 2018.
Weiss EH, Ko CJ, Leung TH, Micheletti RG, Mostaghimi A, Ramachandran SM, et al. Neutrophilic dermatoses: A clinical update. Curr Dermatol Rep 2022; 11(2):89-102.
https://doi.org/10.1007/s13671-022- 00355-8
Pham KNO, Duong MC, Vo DN, Ho DTN. Hand, foot and mouth disease with encephalomyelitis in adult: A case report. Diagn Microbiol Infect Dis 2025; 112(3):116832.
h t t p s : / / d o i . o r g / 1 0 . 1 0 1 6 / j . diagmicrobio.2025.116832
Starkey SY, Mar K, Khaslavsky S, Seeburruth D, Khalid B, Virmani D, et al. Atypical cutaneous findings of hand‐foot‐mouth disease in children: A systematic review. Pediatr Dermatol 2024; 41(1):23-7.
https://doi.org/10.1111/pde.15461
Farah M, El Chaer F, El Khoury J, El Zakhem A. Erythema multiforme‐ like hand, foot, and mouth disease in an immunocompetent adult: a case report. Int J Dermatol 2020; 59(4):487-9.
https://doi.org/10.1111/ijd.14713
Hoang MT Van, Nguyen TA, Tran TT, Vu TTH, Le NTN, Nguyen THN,
et al. Clinical and aetiological study of hand, foot and mouth disease in southern Vietnam, 2013-2015: Inpatients and outpatients. Int J Infec Dis 2019; 80:1-9. https://doi.org/10.1016/j.ijid.2018.12.004
Figueroa SA, Méndez AMP, Espinosa VO. Primary cutaneous diffuse large B-cell lymphoma, leg type. Case report. South Florida J Health 2024; 5(3):e4252.
https://doi.org/10.46981/sfjhv5n3-004
Kurihara M, Yamanishi S, Ozaki S, Pawankar R. A 14-year-old boy with severe erythema multiforme due to amoxicillin. Asia Pac Allergy 2023; 13(3):135-8.
h t t p s : / / d o i . o r g / 1 0 . 5 4 1 5 / apallergy.0000000000000108
Shah SN, Chauhan GR, Manjunatha BS, Dagrus K. Drug induced erythema multiforme: two case series with review of literature. J Clin Diagn Res 2014; 8(9):ZH01-4.
Vukičević Lazarević V. Erythema multiforme: distinguishing hypersensitivity reactions, drug allergy, or herpes simplex infection. Expl Immunol 2025; 5:1003188. https://doi.org/10.37349/ei.2025.1003188
Jung Y, Woo YR, Kim M, Park HJ. Hand-foot-mouth disease mimicking erythema multiforme in an immunocompetent adult. Ann
Dermatol 2022; 34(5):392. https://doi.org/10.5021/ad.20.026
Böer-Auer A, Metze D. Histopathology of hand-foot-mouth disease in adults and criteria for differentiation from erythema multiforme. Am J Dermatopathol 2019; 41(4):273-80.
h t t p s : / / d o i . o r g / 1 0 . 1 0 9 7 / DAD.0000000000001263
Huang CY, Su SB, Chen KT. A review of enterovirus-associated hand- foot and mouth disease: preventive strategies and the need for a global enterovirus surveillance network. Pathog Glob Health 2024; 118(7-
:538-48.
https://doi.org/10.1080/20477724.202 4.2400424
Neri I, Chessa MA, Virdi A, Patrizi Prof A. Hand, foot and mouth disease: An overview of clinical features in adult patients. J Eur Acad Dermatol Venereol 2017; 31(5):e257-9. https://doi.org/10.1111/jdv.14043
Chen Y, Dai B, Han S, Duan G, Yang H, Chen S, et al. Arising concerns of atypical manifestations in patients with hand, foot, and mouth disease. Vaccines (Basel) 2023; 11(2):405. https://doi.org/10.3390/vaccines11020405
Horsten H, Kemp M, Fischer T, Lindahl K, Bygum A. Atypical hand, foot, and mouth disease caused by Coxsackievirus A6 in Denmark: A diagnostic mimicker. Acta Dermato Venereologica 2018; 98(3):350-4. https://doi.org/10.2340/00015555-2853
Mathew B, Thomas S, Velayudhan V, Prasanna R. Hand, foot, and mouth disease in adults: An enigma among diagnosticians: A case series. J Indian Acad Oral Med Radiol 2015; 27(4):616.
