Atypical presentation of painful vesicles on the hands and feet in an immunocompromised adult

Abstract

A 41-year-old Caucasian male presented at the Department of ermatology with a two day history of a painful papulovesicular ruption on the hands and feet (Fig. 1). The lesions started on the almar site of the hands after the patient suffered from fever, genral malaise, and a mild cough. Subsequently, the lesions appeared n the dorsal site of hands and fingers and on the feet as well, xtending to the calves within 48 h. The symptoms started several ours after visiting a public swimming pool. The patient had not een exposed to animals and had not travelled to foreign countries, xcept for Denmark, in the previous weeks. Several days before the tart of the eruption, his six-year-old daughter had been ill and his ife had suffered from herpes labialis. However, the patient had ever had clinical signs of herpes and moreover denied to suffer rom any oral lesions or symptoms. The patient had a history of Wegener’s granulomatosis, diagosed in 1997, for which he was first treated with steroids, yclophosphamide and mycofenolate mofetil (Cellcept®). In 2011 e experienced his last relapse, and eversince used azathiorine 150 mg daily, without signs of a reactivation. Furthermore, e used omeprazole and co-trimoxazole for years and started ydrochlorothiazide three weeks earlier because of hypertension. n addition he suffered from psoriasis vulgaris for years, treated ith topical calcipotriol/betamethasone dipropionate. Dermatological examination on day three of the eruption evealed livid-erythematous, mainly dried up lenticular (papulo) esicles on the palmar and dorsal site of hands and wrists. His feet ere affected with similar lesions and interdigital bullae and ero-