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Viral Infections and Immunology Research / Ocular Diseases and Behçet’s Syndrome / Herpesvirus Infections and Treatments · Journal article
Cureus · August 1, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a case report of probable Coxsackievirus infection in an immunocompetent adult presenting with genital and oral ulcerations, leukocytosis, and systemic inflammation that mimicked HSV and Behçet's disease. The diagnosis rests on serologic elevation (Coxsackievirus A and B titers ≥1:100) without paired titers or lesion PCR, which the authors acknowledge as a limitation precluding definitive confirmation. The case illustrates a rare adult presentation and emphasizes the diagnostic value of considering enteroviral etiologies in sterile mucocutaneous inflammation.
Case report. 33-year-old immunocompetent woman presenting with genital ulcerations, oral ulcers, and systemic inflammatory response.. Intervention: Empiric broad-spectrum antibiotics followed by valacyclovir; dermatologic evaluation and skin biopsy..
33-year-old immunocompetent woman developed severe vulvar ulcerations, oral ulcers, and maculopapular rash with pustules on lower extremities Laboratory findings: white blood cell count 21.3×10⁹/L (85% neutrophils), erythrocyte sedimentation rate 42 mm/h, C-reactive protein 15.4 mg/dL Infectious and autoimmune evaluation was unrevealing; cultures remained sterile despite empiric broad-spectrum antibiotics and valacyclovir
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
This case suggests that Coxsackievirus should be included in the differential diagnosis of genital and oral ulcerations in immunocompetent adults, particularly when bacterial and HSV testing are negative. Clinicians should consider viral serology and avoid prolonged unnecessary antimicrobial therapy in sterile inflammatory mucocutaneous eruptions.
Single case report with presumptive serologic diagnosis lacking confirmatory paired titers or PCR, demonstrating clinical presentation but not establishing definitive etiology or generalizable evidence.
As stated by the source record.
Quoted from the source exactly as published.
This case suggests that Coxsackievirus should be included in the differential diagnosis of genital and oral ulcerations in immunocompetent adults, particularly when bacterial and HSV testing are negative. Clinicians should consider viral serology and avoid prolonged unnecessary antimicrobial therapy in sterile inflammatory mucocutaneous eruptions.
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Disseminated viral infections in immunocompetent adults are uncommon and may mimic autoimmune or bacterial conditions, including Behçet’s disease and disseminated herpes simplex virus (HSV) infection. We report a case of a 33-year-old immunocompetent woman who developed severe, painful vulvar ulcerations, oral ulcers, and a painful maculopapular rash involving both lower extremities that evolved into pustules. She was afebrile and hemodynamically stable but demonstrated a marked systemic inflammatory response, including leukocytosis (white blood cell count: 21.3×10⁹/L; 85% neutrophils) and elevated inflammatory markers (erythrocyte sedimentation rate: 42 mm/h; C-reactive protein: 15.4 mg/dL). Extensive infectious and autoimmune evaluation was unrevealing, and imaging showed no drainable pelvic fluid collection. She received empiric broad-spectrum antibiotics and was transitioned to valacyclovir for suspected disseminated HSV infection; leukocytosis improved rapidly with persistently sterile cultures. Subsequent serologic testing demonstrated elevated Coxsackievirus A and B titers (≥1:100), supporting an enteroviral etiology in the appropriate clinical context; however, the limitations of serologic testing preclude definitive confirmation of acute infection in the absence of paired titers or lesion-based polymerase chain reaction testing. She was transferred to a tertiary center for dermatologic evaluation due to the absence of local specialty services, where skin biopsy demonstrated nonspecific inflammatory changes with negative direct immunofluorescence, arguing against immune complex-mediated vasculitis. This case highlights a rare adult presentation of Coxsackievirus infection with prominent genital and oral ulcerations mimicking HSV and Behçet’s disease, underscoring the importance of considering viral etiologies in sterile inflammatory mucocutaneous eruptions to avoid unnecessary antimicrobial exposure.
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