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Background. The cutaneous manifestations of human enterovirus (HEV) infection are usually limited, such as hand-foot-mouth disease. By comparison, Stevens-Johnson syndrome (SJS) is a life-threatening severe cutaneous adverse reaction (SCAR), mainly caused by drugs. During the HEV outbreaks in 2010–2012 in Taiwan, we identified 21 patients who developed widespread blistering mucocutaneous reactions without any suspected drug causality. Methods. We screened possible pathogen(s) for detecting human herpes virus (HHV1–HHV7), HEV, or Mycoplasma pneumoniae infections using throat swab virus cultures, real-time PCR, DNA sequencing, immunochemistry and electron microscopy analyses. Results. Coxsackievirus A6 (CVA6) DNA was identified in the blistering skin lesions in 6 of 21 patients. Cytotoxic T lymphocytes and natural killer cells expressing granulysin predominantly infiltrated into the skin lesions, sharing the histopathological features with SJS. Intact CVA6 viral particles were identified in the blister fluids and skin lesions by electron microscopy. The phylogenetic analysis of the viral genome showed the CVA6 DNA sequence sharing higher similarity (97.6%–98.1%) to CVA6 strains reported from Finland at 2008. Conclusions. This study identifies a new variant of CVA6 as the causative agent for severe mucocutaneous blistering reactions mimicking SCAR. An awareness of this unusual presentation of HEV infection is needed in the epidemic area.

Mycoplasma pneumoniae infection is a major cause of community-acquired respiratory tract infection in children. We performed a retrospective study to evaluate clinical and demographic data and compare outcomes with and without macrolide treatment in children with M. pneumoniae infection.A total of 139 patients were included in the study and classified into two groups according to whether or not they received macrolide therapy during hospitalization. Data collected included demographic, clinical and laboratory characteristics.Cases were most prevalent during September. Fever and cough were the most common presenting symptoms/signs. The time to fever subsidence did not differ significantly between azithromycin and erythromycin usage. We also found significantly longer fever duration in the group without macrolide usage.Treatment with macrolide shortens fever duration of M. pneumoniae infection in children.