Hand, foot and mouth disease

What it is

Hand, foot and mouth disease is caused by the coxsackie A16 virus. It is one of the causes of acute pharyngitis, listed there beside EBV infectious mononucleosis, which gives pharyngitis, tonsillar exudate, fever, lymphadenopathy, fatigue, rash and splenomegaly.

How it presents

The typical history is a mild systemic upset with sore throat and fever. Vesicles are then seen in the mouth and on the palms and soles of the feet. When a rash sits at these three sites at once, the diagnosis is this and no other.

The other coxsackie A disease of the mouth is herpangina, and the site is what separates them. Herpangina gives sore throat and fever with multiple 1-mm vesicles located on the posterior oropharynx and tonsils, and is managed with analgesics or antipyretics and hydration; hand, foot and mouth disease puts its vesicles in the mouth and on the palms and soles.