Charles Velter

Clinicopathologic analysis of atypical hand, foot, and mouth disease in adult patients

Background Hand, foot, and mouth disease is a contagious viral infection usually affecting children. A resurgence of cases in adults, mainly caused by coxsackievirus A6 and with an atypical and more severe presentation, has taken place. Objective The goal was to examine the clinical, histologic, and immunohistochemical features of this disease in adults. Methods This is a retrospective study on documented cases of adult hand, foot, and mouth disease from France’s Dermatology Department of Strasbourg University Hospital and Bel‐Air Hospital in Thionville. Results Six patients with severe and atypical presentation were included, 4 caused by coxsackievirus A6. The histologic features were: spongiosis, neutrophilic exocytosis, massive keratinocyte necrosis, shadow cells in the upper epidermis, vacuolization of basal cells, necrotic cells in follicles and sweat glands, dense superficial dermal infiltrate of CD3+ lymphocytes, and strong granulysin expression. Limitations This is a retrospective case series. Conclusion In adult patients presenting with atypical hand, foot, and mouth disease caused by coxsackievirus A6, biopsy specimens show distinctive changes in the epidermis but also in adnexal structures. The inflammatory infiltrate is made of T cells with a cytotoxic profile, with numerous granulysin‐positive cells, as observed in severe drug‐induced eruption with necrosis of keratinocytes.

Acute generalized exanthematous pustulosis caused by an iodinated contrast radiocontrast medium for computed tomography arthrography of the knee

Charles Velter1 , Catherine Schissler1, Chloé Moulinas1, Martine Tebacher-Alt2, Jean-Marie Siedel3, Bernard Cribier1 and Dan Lipsker1 1Department of Dermatology, Universite de Strasbourg Faculte de Medecine, Strasbourg 67085, France, 2Faculte de Medecine, Department of Pharmacovigilance, Centre Regional de Pharmacovigilance et d’Information sur les Medicaments Strasbourg, Universite de Strasbourg, Strasbourg 67085, France, and 3Department of Radiology, Cabinet de Radiologie, 67000 Strasbourg, France