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JAMA Dermatology Clinicopathological Challenge
July 2015

Erythematous Papules and Vesicles on the Palms, Soles, and Oropharynx

Author Affiliations
  • 1Center for Clinical Studies, Houston, Texas
  • 2Department of Dermatology, University of Texas Health Science Center at Houston, Houston
JAMA Dermatol. 2015;151(7):783-784. doi:10.1001/jamadermatol.2014.5274

A 23-year-old white man who has sex with men (MSM) presented with a 1-month history of skin lesions on the palms and soles as well as a 2-week history of lesions in his oropharynx. He reported that a fraction of the lesions had blistered earlier in the course of his illness. The patient also described myalgias and fatigue over the preceding month. He moved to Texas from the northeast a few months prior to his illness. He denied any exposure to sexually transmitted infections or a history of genital lesions. On examination, the patient had erythematous papules on bilateral palms and soles as well as eroded vesicles on the palate (Figure, A and B). Lymphadenopathy was not present. A biopsy specimen of a papule on the left sole was obtained for immunohistochemical staining (Figure, C and D). A serologic antibody test revealed an elevated coxsackievirus titer of 1:16 (reference range, <1:8; >1:32 indicative of infection).

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