Hand-Foot-and-Mouth Disease (HFMD) Differential Diagnoses

Updated: Aug 24, 2018
  • Author: Stephen J Nervi, MD; Chief Editor: Michael Stuart Bronze, MD  more...
  • Print
DDx

Diagnostic Considerations

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

Illness

Etiologic Agent

Usual Severity of Clinical Illness

Appearance of Lesions

Locations of Lesions

Other Features

HFMD

Coxsackie-virus A16 (most common), A5, A7, A9, A10, B2, B5

Enterovirus 71

Mild

Papules →

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

Herpangina

Coxsackie-virus A1-A10, A16, A22

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

Moderate; can be severe

Papules →

Vesicles → ulcerations on an erythematous base

Usually 2-4 mm

Posterior oral cavity

Tonsils, soft palate, uvula

Temperature generally high

Herpetic gingivostomatitis

Herpes simplex virus-1

Moderate to severe

Vesicles

ulcerations

Anterior oral cavity

Lips, gingiva, buccal mucosa

Temperature generally high

Lymphadenopathy

Aphthous stomatitis

Unknown

Mild to severe

Ulcerations; larger than in viral enanthems

Lips, tongue, buccal mucosa; generally not diffuse

Afebrile

May be recurrent

Stevens-Johnson syndrome

Immunologic

Moderate to severe

Coalescent vesicles, which then ulcerate

Lips, gingiva, buccal mucosa, tongue, pharynx

Targetlike cutaneous lesions

Diffuse mucous membrane involvement

Differential Diagnoses