Recurrent hand, foot and mouth disease in a patient with common variable immunodeficiency

Background. Common variable immunodeficiency is characterized by hypogammag lobulinemia and recurrent bacterial infections. More uncommonly, these pati ents develop chronic enterovirus infectious meningoencephalitis. Recurrent enterovirus skin infection has not been reported to date in subjects with c ommon variable immunodeficiency. Case report. A 26-year-old man had suffered repeated episodes of otorhinola ryngological and pulmonary infections since childhood. He experienced th re e episodes of vesicular cutaneous eruption involving the palms of both hand s, the plantar aspect of the feet and the buccal mucosa. The patient was ho spitalized in March 1995 at the third episode. Temperature was 38 degrees C . He had maculopapulous and vesicular eruptions on the palm of the hands an d plantar aspect of the feet with irritation in some areas. Petichial lesio ns were seen on the palate. PCR demonstrated viral DNA and cell cultures of a lesion biopsy were positive for enterovirus. Gammaglobulinemia was 4 g/l with low B cell count. Discussion. Viral infections are uncommon in patients with common variable immunodeficiency as cellular immunity remains normal. Severe viral infectio ns caused by enteroviruses have however been reported, generally associatin g chronic, and generally fatal, meningoencephalitis. Our case would be the first case of a recurrent hand, foot and mouth disease in such patients.