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.
Labels: dermatology, hand foot and mouth disease, HFM, medicine, onychomadesis
What is it?
The rash then spread to the rest of the right arm and all extremities. The rash was initially pruritic but by the time of the visit the itching had resolved. He denied any recent OTC medication use except for the daily aspirin. He denied any new or unusual foods or contacts. He was feeling well. He denied fever, nausea, vomiting, diarrhea, abdominal pain or headache. He denied any recent tick bites or possible exposure to ticks. His trunk showed no lesions but his legs were affected as seen below.
There were even some patches near but not connected to the areas that I froze.
by Josh Bazell. Apparently he is a physician and this is his debut novel. I think I downloaded it based on a recommendation from audible.com. The book is relatively short, just over six hours, but it packs a punch. To avoid spoiling the book, I won't tell too much of the story. The protagonist is a medical resident in an internal medicine program in a New York hospital, who got there as a result of his placement in the federal witness protection program due to his involvement with the mob in his earlier life. It is exciting, entertaining and especially poignant for someone who has gone through a medical residency. Even though my training program was not that similar to the hitman doctor's, so much of his experience still rings true. My only minor complaint is that many of the events are way over the top in terms of believability, but I expected that after reading the reviews on Audible. Its kind of like a mix between The Godfather, Rambo and House M.D. There is also a good deal of vulgarity (not a complaint, just a heads up).
