Mistake in diagnosis, Rare disease
Abdulmajeed Mohammed Alajlan, Najlaa Abdulrahman Alsubeeh
Department of Dermatology, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
Am J Case Rep 2020; 21:e927579
Available online: 2020-11-04
Orf, also known as ecthyma contagiosum, is a zoonotic disease caused by a parapox virus, which is endemic in goats and sheep but rare in camels. Orf is usually transmitted to humans who are in contact with infected animals. The clinical manifestation of the disease and a personal history of contact with an infected animal are sufficient to diagnose orf virus infection.
CASE REPORT: In this case report, we present a 42-year-old man with an unremarkable medical history who came into contact with an infected camel and developed a typical orf lesion. There were multiple erythematous, dome-shaped to round painless nodules on the right forearm of the patient. Some of them had coalesced, forming large plaques, and a few nodules had watery or yellowish discharge. The lesion was complicated by lymphadenopathy. The diagnosis of orf was made based upon clinical suspicion. The patient was treated with fusidic acid cream and observed until the lesion resolved spontaneously, leaving some post-inflammatory hyperpigmentation. We believe this is the first report of orf transmission from a camel to a human.
CONCLUSIONS: All physicians should consider this disease as a differential diagnosis in any patient who has a history of contact with camels. Although orf is a self-limiting condition, its early clinical recognition is critical to avoid complications, unwarranted psychological stress, and unnecessary surgical intervention.
Keywords: Camels, Orf virus, Parapoxvirus