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Necrotising fasciitis complicating hand, foot and mouth disease
  1. Clara Smith1 and
  2. John Scott2
  1. 1 Plastic Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK
  2. 2 Canniesburn Plastic Surgery Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
  1. Correspondence to Dr Clara Smith, clara.smith{at}


A literature search confirmed no previous cases of necrotising fasciitis (NF) complicating hand,foot and mouth disease (HFMD). This report explores the case of a previously well 55-week-old Caucasian boy who attended accident and emergency with an acutely swollen right hand and atypical viral rash affecting the hands and face. He was admitted under plastic surgery and treated with intravenous antibiotics and fluid resuscitation for sepsis secondary to cellulitis. Following dermatological review of the rash, a clinical diagnosis of atypical HFMD was made. He deteriorated over the first 12 hours with progression of cellulitis despite intervention. Emergency exploration and debridement were performed for suspected NF. NF was subsequently confirmed by laboratory testing. He required 5 days in paediatric intensive care but made a full recovery. Recent reports highlight an increase in atypical cases of HFMD. Clinicians should be aware of the potential for superadded necrotising infection in cases of atypical HFMD.

  • dermatology
  • paediatrics
  • public health
  • plastic and reconstructive surgery
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  • Contributors CS and JS contributed to the conception of this work. CS identified literature sources and drafted the work, before revising it, and JS revised it critically. CS and JS gave final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.

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