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Hand-Foot-and-Mouth Disease Differential Diagnoses

  • Author: Stephen J Nervi, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Sep 02, 2015
 
 

Diagnostic Considerations

Table 1. Differential Diagnoses of Hand-Foot-and-Mouth Disease (Open Table in a new window)

IllnessEtiologic AgentUsual Severity of Clinical IllnessAppearance of LesionsLocations of LesionsOther Features
HFMDCoxsackie-virus A16 (most common), A5, A7, A9, A10, B2, B5



Enterovirus 71



MildPapules →



Vesicles → ulcerations on an erythematous base



Usually 2-6 mm



Gingiva



Buccal mucosa



Tongue



Pharynx



Lesions may also be found on hands, feet, buttocks, and genitalia.



Low-grade fever



HerpanginaCoxsackie-virus A1-A10, A16, A22



Echovirus 3, 6, 9, 16, 17, 25, 30



Moderate; can be severePapules →



Vesicles → ulcerations on an erythematous base



Usually 2-4 mm



Posterior oral cavity



Tonsils, soft palate, uvula



Temperature generally high
Herpetic gingivostomatitisHerpes simplex virus-1Moderate to severeVesicles



ulcerations



Anterior oral cavity



Lips, gingiva, buccal mucosa



Temperature generally high



Lymphadenopathy



Aphthous stomatitisUnknownMild to severeUlcerations; larger than in viral enanthemsLips, tongue, buccal mucosa; generally not diffuseAfebrile



May be recurrent



Stevens-Johnson syndromeImmunologicModerate to severeCoalescent vesicles, which then ulcerateLips, gingiva, buccal mucosa, tongue, pharynxTargetlike cutaneous lesions



Diffuse mucous membrane involvement



Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Stephen J Nervi, MD Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Stephen J Nervi, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Rajendra Kapila, MD, MBBS Professor, Department of Medicine, Rutgers New Jersey Medical School

Rajendra Kapila, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, Infectious Diseases Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Gary L Gorby, MD Associate Professor, Departments of Internal Medicine and Medical Microbiology and Immunology, Division of Infectious Diseases, Creighton University School of Medicine; Associate Professor of Medicine, University of Nebraska Medical Center; Associate Chair, Omaha Veterans Affairs Medical Center

Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences

Disclosure: Nothing to disclose.

Acknowledgements

Diane H Johnson, MD Assistant Director, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Winthrop-University Hospital, State University of New York at Stony Brook School of Medicine

Diane H Johnson, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Women's Association, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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The lower lip has an ulcer with an erythematous halo.
Table 1. Differential Diagnoses of Hand-Foot-and-Mouth Disease
IllnessEtiologic AgentUsual Severity of Clinical IllnessAppearance of LesionsLocations of LesionsOther Features
HFMDCoxsackie-virus A16 (most common), A5, A7, A9, A10, B2, B5



Enterovirus 71



MildPapules →



Vesicles → ulcerations on an erythematous base



Usually 2-6 mm



Gingiva



Buccal mucosa



Tongue



Pharynx



Lesions may also be found on hands, feet, buttocks, and genitalia.



Low-grade fever



HerpanginaCoxsackie-virus A1-A10, A16, A22



Echovirus 3, 6, 9, 16, 17, 25, 30



Moderate; can be severePapules →



Vesicles → ulcerations on an erythematous base



Usually 2-4 mm



Posterior oral cavity



Tonsils, soft palate, uvula



Temperature generally high
Herpetic gingivostomatitisHerpes simplex virus-1Moderate to severeVesicles



ulcerations



Anterior oral cavity



Lips, gingiva, buccal mucosa



Temperature generally high



Lymphadenopathy



Aphthous stomatitisUnknownMild to severeUlcerations; larger than in viral enanthemsLips, tongue, buccal mucosa; generally not diffuseAfebrile



May be recurrent



Stevens-Johnson syndromeImmunologicModerate to severeCoalescent vesicles, which then ulcerateLips, gingiva, buccal mucosa, tongue, pharynxTargetlike cutaneous lesions



Diffuse mucous membrane involvement



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