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Abstract
The family Picornaviridae is divided into several genera, including the genus Enterovirus, which includes the species Human enterovirus A to -C and Human rhinovirus A to −C. These viruses are frequently associated with respiratory and gastrointestinal diseases. Coxsackie virus and echoviruses can induce a rash in children, such as hand-foot-and-mouth disease caused by coxsackie virus A16, while rhinoviruses are associated mainly with respiratory infections.
We describe a clinical case of mild rhinitis in a 9-week-old female infant with HBoV and enterovirus co-infection accompanied by an unusual rash that strongly resembled granuloma annulare, having plaques with raised non-scaly erythematous borders. The child was afebrile, displayed a garland-like rash that within minutes changed its pattern and had moderately elevated expression of tryptase. No other pathogens were detected.
It was concluded that the rash originated from the double infection with enterovirus and HBoV, as no further rash-associated pathogens were detected. The case is important as it is the first description, to the best of our knowledge, of this unusual rash seen with enterovirus/HBoV co-infection, and as this condition should be taken into account in future.
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