SHM Converge Scientific Abstract ePoster Gallery-Erythema Multiforme Secondary to Orf Virus Infection: A Case Report

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This case report describes a 38-year-old woman who developed a painful lesion on her left index finger that was initially mistaken for a wart, cellulitis, or keratoacanthoma. She later developed widespread targetoid rash, hand and leg swelling, and polyarthralgias. After further history, she recalled slaughtering sheep for an Eid celebration, suggesting exposure to Orf virus, a zoonotic parapoxvirus transmitted from sheep and goats through broken skin.<br /><br />Orf virus usually causes a localized, self-limited skin lesion that progresses from a papule to a weeping target lesion and then an ulcer before resolving in about 4–6 weeks. It is most commonly seen in people with occupational or cultural exposure to livestock, such as shepherds, farmers, butchers, and veterinarians. Although usually benign, it can rarely be complicated by erythema multiforme (EM).<br /><br />In this patient, bacterial cultures and HSV PCR were negative. Dermatology favored Orf virus infection, although PCR testing for Orf was unavailable. A few days later, she presented with a diffuse blanching targetoid maculopapular rash involving the palms, soles, and extremities, consistent with EM secondary to Orf infection. Laboratory tests showed elevated inflammatory markers (CRP and ESR) but normal liver function. She was treated with a prednisone taper and antihistamines, with improvement in rash and pain within days. She had no mucosal, ocular, or skin sloughing and no systemic symptoms.<br /><br />The report emphasizes the importance of taking a detailed exposure history, including animal and livestock contact, especially in religious or cultural contexts where sheep and goat exposure may occur. Early recognition of Orf-related erythema multiforme can prevent misdiagnosis and guide effective treatment.

Asset Subtitle

Omar Badawi, MD

Meta Tag

Author List David Sypert, DO, Jay Anderson, Omar Badawi, MD, Shaili Kothari, MD

Category Clinical Vignettes

Concept Orf Virus

Concept Erythema Multiforme

Concept Parapoxvirus

Concept Zoonosis

Concept Skin Breakdown

Distinguished Non-Finalist

Presenter Organization Riverside Methodist

Presenting Author Omar Badawi, MD

Track Adult

Keywords

Orf virus

erythema multiforme

zoonotic parapoxvirus

sheep exposure

targetoid rash

hand swelling

polyarthralgia

occupational exposure

prednisone taper

livestock contact

Orf Virus

Erythema Multiforme

Parapoxvirus

Zoonosis

Skin Breakdown