Download Erythema multiforme as a result of Orf disease

Erythema multiforme as a result of Orf disease
Abstract:
Orf is a mucocutaneous disease occurs by contact of nonintact skin through of contaminated saliva of sheep.
Erythema multiforme and or Stevens-Johnson syndrome,s common causes are herpes simplex virus,mycoplasma
pneumonia and drugs (8). But its evolution following Orf is rarely seen at clinical practice.In this study we present
two cases of erythema multiform following orf.
1-A 45 year old woman admitted in our emergency room with Erythema multiforme and orf lesions in her hand
that completely relieved after supportive therapy.
2-The second was a 32 years old woman admitted to our hospital with erythema multiforme lesions and related
finger nodules.
The systemic eruptions were cured within 6 days and Orf lesions for 5 weeks.
Key words: Orf , Erythema multiforme
Introduction:
Orf is a mucocutaneous disease caused by parapoxviruses, containing double-stranded DNA. (1,2)
Other names of it included sheep pox, ecthyma contagiosum contagious pustules. (3)
Transmission to humans occurs by contact of nonintact skin through of contaminated saliva of sheep and goats
and their inanimate objects (4) .In humans, the incubation period varies from 3 to 10 days and then evolves single
or multiple lesions, which arise mostly in the hands and face.At the onset of the disease , primary lesions are the
papules that gradually progresses to the nodular patterns. The nodules change into tubercule or crusted form
within 4-6 weeks ( 5) .The lesions may complicated to lymphangitis or secondary bacterial infections. rare systemic
complications such as erythema multiforme, maculopapular rash , generalized lymphadenopathy are seen during
the course of the disease (6, 7).In this study we present two cases of erythema multiform following orf.
Case presentation:
1-A 45 year old woman admitted in our emergency room with chief complaint of generalized erythema , low fever
, and mild itching . several target lesions and purple nodules with a brief fluctuation were found in the first
phalange of right index finger and in the third phalange of right finger. She noted that she cleaned KALE-PACHE 30
days ago. Finger lesions appeared 3 days after that and gradually enlarged. Warm compresses and low dose of
corticosteroids administered . the generalized eruptions were disappeared within five days with complete
recovery of them after 6 weeks(figure-1).
2-The second was a 32 years old woman admitted to our hospital with erythema multiforme lesions and related
finger nodules.
She remembered exposure to the head of a sheep and bite of the finger. Three days after that,the lesions was
appeared on her first phalange of right thumb. After ten days,generalized erupotions were appeared throughout
of her body. Supportive therapy with low doses of corticosteroid were given.The systemic eruptions were cured
within 6 days and Orf lesions for 5 weeks(figure-2).
(figure-1)
(figure-2)
Discussions:
Erythema multiform is caused by several etiologic reasons, the most common is herpes simplex virus,mycoplasma
pneumonia and drugs(8). But its evolution following orf is rarely seen at clinical practice.In this study we present
two cases of erythema multiforme following Orf.During Eid-Ul-Adha more than million sheeps kill and slaughter
by muslim countries. Slaughtering and providing of sheep by sheeperd or housewife and minimal trauma to the
hand of them may cause Orf.Diagnosis of Orf disease usually based on physical examination and the history of
infected animal exposure (9).In most cases, the lesions are self-limited and only topical treatment with
preservatives added to prevent bacterial infections is sufficient(10).Enhanced immune response to the virus may
explain the incidence of erythema multiforme in some people(11).many literatures reported instances or erythema
multiforme following Orf disease who didn’t take any antibiotic and have no disease contribute to erythema
multiforme (12,13,14,15) .Therefore Orf seems can trigger immune system and cause skin reactions. But more
investigation needs to prove this idea.In two patients presented with low-dose corticosteroid , supportive care,
erythema multiforme were improved waste and waste fingers were cleared within a few weeks without obvious
scarring.
Conclusion:
So in endemic regions erythema multiforme should be considered in the differential diagnosis of patient with
erythema multiform or Stevens-Johnson syndrome as the possible cause the disease.Finally , Orf is a self limited
disease. But early diagnosis can prevent unnecessary interventions.A careful history of the patient can help in the
diagnosis of the disease.Having knowledge about rare diseases, such as bullous pemphigoid or erythema
multiforme like lesions help doctors to diagnose and treat these complications in a timely manner.
Acknowledgments: We thank to all staffs at the Rohani Hospi-tal, Babol, for their help and assistance.
Conflict of interest: None.
Funding Support: None.
Author’s Contributions:None.
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