Contagious Ecthyma
A 34-year-old farmer presented to our emergency department with a painful rash with purulent-appearing papules on his hands (Panels A and B). The rash had been worsening over the previous 21/2 weeks. The physical examination was otherwise unremarkable. The patient manages livestock on his farm. The rash began a few days after a sheep bit his left hand while being bolus-fed. The patient was experienced in sheep care and reported that multiple animals on his farm had “sore mouth disease.” He did not wear gloves while performing the feeds. Initial differential diagnosis included herpetic whitlow, cutaneous anthrax, methicillin-resistant Staphylococcus aureus infection, and poxvirus infection. Lesional swabs were sent to the Centers for Disease Control and Prevention, where polymerase-chain-reaction assay confirmed the suspected diagnosis of contagious ecthyma, a zoonotic infection caused by the orf virus. This viral infection is typically self-limited in immunocompetent patients. The patient was treated conservatively with routine wound care and antibiotic agents for possible bacterial superinfection. His lesions resolved completely over a period of 3 weeks. To prevent recurrent infection, the patient was advised to use gloves when he handled the animals or any potentially contaminated equipment.
