The symptoms in an 8-year old girl started with an upper respiratory tract infection and sore mouth. The hand, foot and mouth disease skin lesions appeared after a couple of days in the lower extremities. The skin manifestations were exceptionally severe. The general condition of the child, however, remained good even if she was feverish, and pain in the feet prevented walking. The diagnosis was confirmed by enterovirus nucleic acid assay. The patient recovered and was symptomless within a week.