FOAMed Question of the day 8 #FOAMedQOTD

 Name 2 possible conditions which would cause this lesion on a farmers hands and how you might differentiate the two.

skin lesion

Answer

Comments

  1. Chris Cole (@doconskis) says:

    ORF !!

    I reckon it’s Orf. :-)

  2. Cattle farmer?

    Brucellosis and Mycobacterium bovis can both cause ulcerating lesions of the skin like that. My gut instinct is to take a biopsy.

  3. Malin Zachau says:

    Hi ,
    It could be either orf, caused by the parapox virus carried by sheep and goats
    or pyoderma gangrenosum, which is a neutrophilic dermatosis.

    The latter is supposedly very painful .

    Malin

  4. Tom Mitchell says:

    Hmm…
    Orf – if they have sheep/goats – ask them if any of their animals are suffering. Do you get this in NZ?
    Burn – history
    Abscess/FB – history
    What about a (brown?) spider bite? Didn’t get many of these in Wellington.

    I like this format Keeweedoc! Gets the ‘little grey cells working’ Poirot style

  5. Chee Yong Chuan says:

    Orf and Milker’s nodule. Both are zoonosis caused by parapoxvirus. Other than a different exposure history, the presentation, course and treatment of milker’s nodules are essentially identical to off. Definite differentiation is unnecessary, but can be accomplished through viral culture, PCR and histologic examination

  6. Meite Moser says:

    Likely Cutaneous Anthrax-
    DDx- Tularemia,Herpes Lesion, Bacterial Abscess ( MRSA)
    Dx- C&S, Bloos titers

  7. I should have remembered orf – I had a patient with it. Had smaller lesions, though.

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