A Rare Presentation of a Common Childhood Viral Exanthem in an Immunocompromised Adult

Abstract

Introduction: Viral exanthems are described as eruptions over the skin due to viral infections. These usually follow a characteristic pattern for specific infections and may be associated with systemic features. Often, the diagnosis is clinical. Occasionally, the presentations can be atypical, especially in individuals with pre-existing comorbidities, leading to diagnostic difficulty. In such cases, vigilant observation, appropriate laboratory evaluation, and follow-up are required. Herein, we report a rare clinical presentation of a viral exanthem in an immunocompromised woman. Case Presentation: A 50-year-old female with peripheral T-cell lymphoma on chemotherapy presented with abrupt-onset asymptomatic fluid-filled lesions all over her body. She was provisionally diagnosed as a case of varicella and started on Acyclovir with symptomatic treatment. However, the progressive worsening of the rash and prolonged course prompted further evaluation. The Quantitative Reverse Transcription Polymerase Chain Reaction (qRT-PCR) test was positive for pan-enterovirus, which confirmed the final diagnosis of hand-foot-mouth disease (HFMD). Acyclovir was continued for 2 weeks, leading to the eventual resolution of the vesiculo-bullous lesions with the formation of adherent ecthyma-like black crusts and a few partially blanchable purpura-like macules. No new crops appeared during the course of treatment. However, after 6 weeks from the onset of skin lesions, the patient succumbed to bacterial pneumonia. Conclusions: The HFMD, though rare in adults, warrants its inclusion in the differential diagnosis of sudden-onset atypical vesiculobullous lesions in immunocompromised patients. Management can be challenging due to atypical presentations and a variable, protracted course, necessitating extended treatment and follow-up.