Orf Infection on the Scalp of a Taiwanese Woman: A Case Report and Literature Review

Abstract

Background: Orf, or ecthyma contagiosum, is a zoonosis caused by Parapoxvirus that infects sheep and goats. Human transmission typically occurs in persons in contact with the infected animals or contaminated fomites and environment. In humans, it generally occurs as solitary or multiple skin lesions on the hands or fingers. Involvement of the head region has rarely been reported.

Case presentation: We report an unusual case with multiple orf lesions on the scalp of a middle-aged woman, along with a review of previously reported Orf cases on the head region.

Conclusions: Although Orf infection rarely happens on the head region, it should be considered in the differential diagnosis of cases with relevant animal exposure.

Keywords: Orf; Orf virus; Parapoxvirus; ecthyma contagiosum; zoonosis.

Figure 1

(a) One of the four large erythematous, weeping, and infiltrated noduloplaque with surface cobblestone appearance over scalp; (b) close-up view of the 4 × 4 cm noduloplaque over vertex scalp; (c) the epidermis revealed acanthosis with finger-like downward projections. Prominent papillary dermal edema and heavy lymphohistiocytic infiltration extended from upper dermis to reticular dermis (H&E, ×50); and (d) koilocytic change of the upper epidermis and intracytoplasmic eosinophilic inclusions (white arrows) in vacuolated epidermal cells (H&E, ×400).

Figure 2

(a) The DNA product was run on 2% agarose gel. The size of the DNA products was 147 bp and (b) the DNA sequence specific for B2L gene was confirmed using next generation sequencing (marker is Bio-25 bp DNA ladder).