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Case Reports in Medicine
Volume 2010, Article ID 524021, 3 pages
Case Report

A Man with an Umbilicated Papule of the Hand: What Is Your Diagnosis?

1Department of Pathology, Creighton University Medical Center, Omaha, NE 68131, USA
2Department of Dermatology, Creighton University Medical Center, Omaha, NE 68131, USA

Received 9 March 2010; Accepted 2 April 2010

Academic Editor: Stephen A. Klotz

Copyright © 2010 Deba P. Sarma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Ecthyma contagiosum is a zoonotic disease caused by the parapoxvirus that causes “sore mouth” in sheep and goats and orf in human. Case Presentation. A 61-year-old sheep farmer presented with a painful non-pruritic lesion on the left hand that had been present for approximately 5 weeks. Physical examination demonstrated a 1 cm pearly, umbilicated papule with raised borders. A biopsy showed an asymmetrical nodule with parakeratotic crust and acanthosis with thin epidermal strands extending deeply in the underlying dermis. Marked edema, capillary proliferation and extensive lymphocytic infiltration was also present. One red intranuclear inclusion was identified in an epidermal keratinocyte. A diagnosis of human orf (ecthyma contagiosum) was made. Conclusion. Infected sheep and freshly vaccinated sheep or goats are the reservoir for human infection. After an incubation period of 3–7 days, parapoxvirus infections produce 1–3 painful lesions measuring 1-2 cm in diameter. The natural history of the disease is complete resolution and no treatment is indicated. Prevention of echthyma contagiosum in ruminants through vaccination is thought to be the best way to control infection.