Snapshot A 2-year-old girl is brought to her pediatrician’s office for a new rash on the palms and soles that developed yesterday. For the past few days, she has had low-grade fevers and a slight cough, and of note, her 6-year-old sister had similar symptoms. Upon further questioning, she and her sister have had all routine childhood vaccinations. On physical exam, there are multiple 2-3-mm grey vesicular lesions on the bilateral palms and soles and several vesicles and ulcers on the oral mucosa. The physician informs her parents that this disease typically resolves spontaneously and to keep the patient hydrated. Introduction Classification coxsackievirus an enterovirus that belongs to the picornavirus family non-enveloped, icosahedral capsid, linear, single-stranded, positive-sense RNA virus transmission via oral secretions or feces coxsackievirus type A hand, foot, and mouth disease herpangina coxsackievirus type B most commonly causes a nonspecific prodrome myocarditis pericarditis Epidemiology Incidence common among children Demographics more common in children than adults Risk factors exposure to others with the virus daycare centers poor hygiene finger sucking ETIOLOGY Pathogenesis once infected, the virus will travel to the lymph nodes and incubate, causing a prodrome Presentation Symptoms prodrome flu-like illness low-grade fevers may have a cough malaise painful oral lesions skin rash may be painful Physical exam greyish-yellow vesicles or erythematous papules on the palms and soles vesicles and ulcers in oral mucosa and around the mouth Studies Labs coxsackievirus-specific immunoglobulin A viral culture Differential Rickettsia rickettsii infection distinguishing factor presents with rash on palms and soles but is often not macular and vesicular in nature Chickenpox distinguishing factor pruritic,vesicular rash that typically does not occur on the palms, soles, and oral mucosa DIAGNOSIS Making the diagnosis based on clinical presentation but may be confirmed with laboratory studies Treatment Management approach mainstay of treatment is supportive care Conservative supportive care indication all patients modalities antipyretics analgesics hydration Complications Aseptic meningitis Guillain-Barre syndrome Prognosis Spontaneously resolves