Case Report
Open Access Peer-reviewed

Symptom Resolution in Acyclovir Treated Hand, Foot, and Mouth Disease

Paul Gursky1, Jennifer Nguyen1,, Bryan Pacheco1, William Butler1, Melodie Mope MD2

1Florida State University College of Medicine, Orlando Campus, Orlando, FL USA

2Orlando Health Physicians Associates, Orlando, FL USA

American Journal of Medical Case Reports. 2020, 8(12), 456-458. DOI: 10.12691/ajmcr-8-12-6
Received July 20, 2020; Revised August 22, 2020; Accepted August 31, 2020

Abstract

Background: Hand, Foot, and Mouth Disease (HFMD) is a highly contagious virus primarily affecting young children, but may also impact older children and adults. Initial symptoms typically manifest as fever, malaise, and pharyngitis, followed by eruption of erythematous, papular lesions on the palms and soles. HFMD is typically treated with supportive care, as there is no current gold standard therapy for HFMD. However, based on previous case studies, acyclovir has demonstrated its potential as a viable treatment for HFMD. Case Presentation: A 37-year-old female patient presented to the clinic with a two-day history of fever, malaise, pharyngitis, and papulovesicular skin lesions on her hands and feet. A clinical diagnosis of HFMD was made, and the patient was promptly started on oral acyclovir 800 mg, three times daily for seven days. Within two days of acyclovir treatment, the patient’s fever subsided, and the skin lesions on the hands and feet were fully resolved. Conclusion: Our case report showcases the benefits of acyclovir therapy in treating HFMD. Acyclovir treatment provided our patient symptomatic relief, resulting in defervescence and complete resolution of skin lesions. Symptom duration and severity were lessened significantly within the first couple days of therapy. Acyclovir therapy has shown promising results for potential HFMD treatment, and we encourage additional studies to further evaluate its efficacy.

Keywords:

hand, foot, and mouth disease, acyclovir, coxsackievirus, pediatric rash
[1]  Robinson CR, Doane FW, Rhodes AJ. Report of an Outbreak of Febrile Illness with Pharyngeal Lesions and Exanthem: Toronto, Summer 1957—Isolation of Group A Coxsackie Virus. Can Med Assoc J. 1958 Oct 15; 79(8): 615-621.
 
[2]  Kaminska K, Martinetti G, Lucchini R, Kaya G, Mainetti C. Coxsackievirus A6 and Hand, Foot and Mouth Disease: Three Case Reports of Familial Child-to-Immunocompetent Adult Transmission and a Literature Review. Case Rep Dermatol. 2013 Aug 7; 5(2): 203-9.View Article  PubMed
 
[3]  Second J, Velter C, Cales S, Truchetet F, Lipsker D, Cribier B. Clinicopathologic analysis of atypical hand, foot, and mouth disease in adult patients. J Am Acad Dermatol. 2017: 76(4): 722.View Article  PubMed
 
[4]  Kataria A, Chagarlamudi H, Carbono J, Aazim A, Mope M. Three cases of intra-familial transmission of hand, foot and mouth disease treated with acyclovir. American Journal of Medical Case Reports. 2019; 7(9): 219-222.View Article
 
[5]  Romero JR, Modlin JF. Introduction to the human enteroviruses and parechoviruses. 8th ed. Philadelphia: Elsevier Saunders; 2014. Pp. 2066-2068.
 
[6]  Huang C, Liu CC, Chang YC, Chen CY, Wang ST, & Yeh TF. Neurologic Complications in Children with Enterovirus 71 Infection. New England Journal of Medicine, 341(13), 936-942.View Article  PubMed
 
[7]  Aswathyraj S, Arunkumar G, Alidjinou EK, Hober D. Hand, foot and mouth disease (HFMD): emerging epidemiology and the need for a vaccine strategy. Medical Microbiology and Immunology, 205(5), 397-407.View Article  PubMed
 
[8]  Faulkner CF, Godbolt AM, Deambrosis B, Triscott J. Hand, foot and mouth disease in an immunocompromised adult treated with aciclovir. Australasian Journal of Dermatology, 44(3), 203-206.View Article  PubMed
 
[9]  Shelley WB, Hashim M, Shelley, ED. Acyclovir In The Treatment Of Hand-Foot-And-Mouth Disease. The Pediatric Infectious Disease Journal, 15(9), 844.View Article
 
[10]  Mirand A, Henquell C, Archimbaud C, Ughetto S, Antona D, Bailly JL, Peigue-Lafeuille H. Outbreak of hand, foot and mouth disease/herpangina associated with coxsackievirus A6 and A10 infections in 2010, France: a large citywide, prospective observational study. Clinical Microbiology and Infection, 18(5).View Article  PubMed
 
[11]  Abzug MJ. The enteroviruses: Problems in need of treatments. Journal of Infection, 68(1), 108-114.View Article  PubMed
 
[12]  Mary G. McIntyre, et al. Notes from the Field: Severe Hand, Foot, and Mouth Disease Associated with Coxsackievirus A6 — Alabama, Connecticut, California, and Nevada, November 2011 - February 2012. Morbidity and Mortality Weekly Report, Center for Disease Control, 61(12), 213-214.
 
[13]  Ehrenfeld E, Domingo E, Roos R. The Picornaviruses. Washington DC: American Society for Microbiology Press; 2010. Pp. 800-802.View Article
 
[14]  Desmond RA, Accortt NA, Talley L, Villano SA, Soong SJ, Whitley RJ. Enteroviral meningitis: natural history and outcome of pleconaril therapy. Antimicrob Agents Chemother. 2006 July; 50(7): 2409-2414.View Article  PubMed
 
[15]  Florea NR, Maglio D, Nicolau DP. Pleconaril, a Novel Antipicornaviral Agen. Pharmacotherapy, 23(3), 339-348.View Article  PubMed
 
[16]  Abed T, Boivin G. Treatment of respiratory virus infections. Antiviral Research, 70(2), 1-16.View Article  PubMed
 
[17]  Jetsadawisut W, Nutho B, Meeprasert A, Rungrotmongkol T, Kungwan N, Wolschann P, Hannongbua S. Susceptibility of inhibitors against 3C protease of coxsackievirus A16 and enterovirus A71 causing hand, foot and mouth disease: A molecular dynamics study. Biophysical Chemistry, 219, 9-16.View Article  PubMed
 
[18]  Elion GB. Mechanism of action and selectivity of acyclovir. The American Journal of Medicine, 73(1), 7-13.View Article
 
[19]  Taylor M, Gerriets V. Statpearls, Acylovir. Treasure Island: StatPearls Publishing; 2020.
 
[20]  Repass G, Palmer W, Stancampiano F. Hand, foot, and mouth disease: Identifying and managing an acute viral syndrome. Cleveland Clinic Journal of Medicine, 81(9), 537-543.View Article  PubMed
 
[21]  Cox JA, Hiscox JA, Solomon T, Ooi M-H, Ng LFP. Frontiers in Microbiology. 2017 November; 8(2249), 1-14.View Article  PubMed
 
[22]  Dhananjay D. Indian Journal of Drugs in Dermatology, 2018 December; 4(2), 73-75.View Article