Human Orf: An Under-Recognized Zoonotic Infection

References • 58-year-old Arab male • Progressively enlarging reddish swelling over radial aspect of right index finger 3 weeks minimal local discomfort • Initially began as a red small patch and rapidly worsened to occupy half the finger • Denied fever, night sweats, weight loss or other systemic symptoms • No pets at home • Patient recollected having slaughtered a sheep in observance of a ritual for the religious festival of Eid Al-Adha one week prior to the onset of the lesion • PMH: hypertension, dyslipidemia, vitiligo • A reddish, violaceous target-like plaque (2.5 x 2.5 cms size) (figure 1) with a central yellowish-white area which appeared pus filled, with a surrounding bulla, and a bright red rim • Aspiration attempted from the lesion did not yield any fluid or pus • Systemic examination unremarkable. • Treated with oral augmentin, local fucidin ointment and saline compresses for presumed abscess • After a week, patient presented to ER with rapid increase in size of the lesion, and axillary tenderness. The lesion had become more flattened out with a raw granulomatous appearing base (figure 2) • Tender axillary lymphadenopathy of the same side noted