Loss of Nails Following Hand Foot and Mouth Disease Infection in 2 Children

I present an unusual case of 2 unrelated children who coincidentally presented to me on the same day with Hand, Foot, and Mouth Disease and then returned 7 and 8 weeks later with the same uncommon complication of this disease.

The first was an otherwise healthy 3 year old boy whose symptoms at presentation were a 2 day history of fever up to 102 degrees, and a vesicular rash on the hands, feet, buttocks and around the mouth.  A diagnosis of hand, foot and mouth disease was made, he and mom were sent home with reassurance.  No further contact was made until he presented 7 weeks later with his mother who was complaining that his nails were peeling off.  He had no other symptoms.  I had no specific explanation for this, so I inquired about any recent systemic illnesses.  She reminded me of the recent HFM infection so I did some quick research - Google Search:  "hand foot mouth disease onycholysis" and I found this article.  It describes 4 cases of onycholysis and/or onychomadesis following HFM infection.

 

 The second case involved a 20 month old girl who had initally presented with 2 day history of temp. up to 99.8 and vesicular rash on hands, feet and groin area.  The diagnosis of hand, foot and mouth disease was made and reassurance was given.  A few days later she returned with worsening of the rash but had no significant feeding problems.  There were no signs of dehydration or fever at that time, but the child now was extensively covered with the vesicular rash over all extremities, trunk and external lips.  No further treatment was recommended at that time and f/u by telephone a few days later revealed that she was finally improving and further follow up for this was planned on an as needed basis.  Our next encounter was just under 8 weeks later for an unrelated minor problem.  As we were finishing the visit, the mom said "All her fingernails and toenails fell off after she had that hand foot and mouth disease".  Indeed, on her exam, all of her fingernails had shed and were growing back with some small irregularities and indentations and the same was true for her toenails except the nail of each great toe which had not completely lost the older portions of the nails.

 

Wikipedia - Onychomadesis