Orf virus infection after Eid al-Adha

Abstract

Human orf, also called ecthyma contagiosum, is a zoonotic infection that causes self-resolving skin lesions after contact with infected livestock. We present the case of a 45-year-old Moroccan-born man who developed multiple painful erythematous, violaceous plaques on his hands after butchering a sheep to celebrate the Muslim holiday Eid al-Adha. The diagnosis of orf virus infection was established based on exposure history, histopathology, and classic skin lesions. Although orf virus infection is traditionally seen in individuals with frequent animal contact such as farmers and veterinarians, clinicians evaluating suspicious lesions in patients without occupational risk factors should consider additional cultural practices that may expose the patient to orf virus.

Keywords: Ecthyma contagiosum; Eid al-Adha; Muslim holiday; Orf virus; Ulcerative skin lesions; Zoonotic infection.

Fig. 1

A) Violaceous, targetoid plaque with central necrosis and peripheral rim of erythema on the dorsal second digit of the right hand just proximal to the proximal interphalangeal joint. B) Violaceous, smooth, dome-shaped nodule with central dusky blue hue and fissure as well as peripheral rim of erythema on the dorsal fifth digit of the right hand overlying the distal interphalangeal joint. C) Edematous periungal plaque with dull erythema at the junction of the proximal and lateral nail folds of fourth digit of the left hand. D) Thin erythematous periungal plaque with fine collarette of scale on the proximal and lateral nail folds and skin overlying the distal interphalangeal joint of the fourth digit of the left hand. This image was taken fifteen days later, when the lesions were healing in the regression stage. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).

Fig. 2

Biopsy reveals prominent dermal edema with subepidermal blister formation (arrowhead), necrosis of the dermis (arrow), scattered perivascular and interstitial neutrophil infiltrate (asterisk), vascular dilation, and inclusion bodies with vacuolated keratinocytes (circle, magnified in bottom right) (Hematoxylin-eosin stain; original magnification 100×).