Hand, foot, and mouth disease and palmoplantar erythrodysesthesia in a breast cancer patient: a challenging diagnosis

Dora Mancha, Service of Dermatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portuga Claúdia Brazão, Service of Dermatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portuga Pedro M. Garrido, Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal Luís Soares de Almeida, Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário; Unit of Research in Dermatology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon. Lisbon, Portugal Paulo Filipe, Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN); Dermatology Universitary Clinic; Dermatology Research Unit, Instituto de Medicina Molecular. Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal

Cancer patients may experience several dermatological symptoms during treatment. We describe a case of synchronous presentation of hand, foot, and mouth disease (HFMD) and palmoplantar erythrodysesthesia (PPE) in a breast cancer patient. A 36-year-old female breast cancer patient under chemotherapy presented to our consult with a 1-week history of painful palmoplantar lesions associated with the recent onset of fever and dry cough. Her daughter had been diagnosed with HFMD. There was a positive immunoglobulin M (IgM) and IgG serology for coxsackievirus. We performed two skin biopsies; one specimen was consistent with HFMD, and the other one was with PPE. To the best of our knowledge, the synchronous presentation of HFMD and PPE has not yet been reported in the literature to date. PPE and immunosuppression might have been responsible for the atypical presentation and clinical severity of HFMD.