A 4-year-old child presents with ulcers on the tongue and oral mucosa, with vesicles on the palms, soles, and interdigital spaces. Which diagnosis is most likely?

A 4-year-old child presents with ulcers on the tongue and oral mucosa, with vesicles on the palms, soles, and interdigital spaces. Which diagnosis is most likely?

• A. Infectious mononucleosis
• B. Rubeola
• C. Hand-foot-and-mouth disease
• D. Herpangina

Answer: (C)

Vesicular lesions on the hands and feet together with ulcers on the tongue and other oral mucosa in a young child are classic for hand-foot-and-mouth disease. This enteroviral infection, most commonly caused by Coxsackie A viruses, typically affects children under 5. The oral lesions start as vesicles that quickly ulcerate, and a separate set of vesicles appears on the palms, soles, and sometimes interdigital areas. Fevers, sore throat, reduced appetite, and general malaise are common, and the illness is usually self-limited over about a week to 10 days. This presentation helps distinguish it from other illnesses. Herpangina also involves oral ulcers but lacks the characteristic hand and foot involvement. Measles features a high fever and a characteristic rash with Koplik spots, not vesicles on hands/feet. Infectious mononucleosis tends to present with fever, fatigue, sore throat, and lymphadenopathy rather than a vesicular hand–foot eruption. Management is supportive: ensure hydration, use analgesics for pain, and offer soft, bland foods; avoid acidic/spicy foods and aspirin in children. Maintain good hand hygiene to reduce transmission.

Vesicular lesions on the hands and feet together with ulcers on the tongue and other oral mucosa in a young child are classic for hand-foot-and-mouth disease. This enteroviral infection, most commonly caused by Coxsackie A viruses, typically affects children under 5. The oral lesions start as vesicles that quickly ulcerate, and a separate set of vesicles appears on the palms, soles, and sometimes interdigital areas. Fevers, sore throat, reduced appetite, and general malaise are common, and the illness is usually self-limited over about a week to 10 days.

This presentation helps distinguish it from other illnesses. Herpangina also involves oral ulcers but lacks the characteristic hand and foot involvement. Measles features a high fever and a characteristic rash with Koplik spots, not vesicles on hands/feet. Infectious mononucleosis tends to present with fever, fatigue, sore throat, and lymphadenopathy rather than a vesicular hand–foot eruption.

Management is supportive: ensure hydration, use analgesics for pain, and offer soft, bland foods; avoid acidic/spicy foods and aspirin in children. Maintain good hand hygiene to reduce transmission.