A. Ingham,R. Manifold,L. Gordon
Orf in humans is caused by direct inoculation with
parapoxvirus from infected sheep and goats. A recent study
in Australian sheep found 0.03% are infected (1). We report
a rare case of multiple orf in a healthy 16-year-old boy. He
reported a one week history of erythematous haemorrhagic
exophytic nodules arising on his left arm following a sheep
shearing session a week prior on his property in rural New
South Wales. The lesions had arisen within the locations of
trauma from the shears to his forearm and hand and some
up to 4 cm in size. The lesions were further traumatised by
the patient’s attempts to remove burrs from his skin with a
sewing needle.
He was initially commenced on oral clindamycin as a
diagnosis of MRSA abscesses was considered. Following
dermatology consultation, an incisional biopsy was taken
and histology was supportive of orf. He was treated with
three weekly application of topical imiquimod with good
effect.
Our case highlights that multiple lesions of orf can arise in
healthy hosts in instances of widespread trauma to the skin.
Recognition of these lesions is important to ensure appropriate
treatment is administered and adequate reassurance
given to patient regarding self-resolution.