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Hand, foot, and mouth disease (HFMD) is a febrile illness that often includes a papulovesicular rash in the affected areas. It is relatively common in children in the summer and fall and is most commonly caused by an enterovirus, coxsackievirus A16 (CVA16).
On July 7, 2015, a 22-year-old man in training at Lackland Air Force Base in Texas presented at sick call with crusted erythematous papulovesicular lesions on the extensor surfaces of his upper and lower extremities. He had no oronasal lesions and was afebrile. Initial diagnostic possibilities included Henoch-Schönlein purpura, parvovirus B19 infection, and Rocky Mountain spotted fever. HFMD was also in the differential diagnosis despite the absence of oral lesions. Viral cultures and ski…