title: Erythema multiforme after orf virus infection: a report of two cases and literature review.
abstract: Orf virus has a worldwide distribution among sheep and goats. The hypersensitivity reaction erythema multiforme (EM) is a known complication of orf infection in humans; however, its occurrence is poorly understood and has not been extensively reviewed. We present two unrelated cases of orf-associated EM, and a review of the literature, highlighting important clinical, epidemiological and immunological aspects of this condition. Orf and its associated complications can occur in rural areas, as well as urban settings, where it is less well-known, through religious or cultural practices involving animal slaughter. Obtaining a history of animal exposures from patients with lesions suspicious for orf and secondary skin eruptions can guide diagnosis and identification of the inciting immune stimulus. Determining the pathophysiology and relative contribution of host and viral factors contributing to EM and other orf-associated hypersensitivity reactions could facilitate the identification of risk factors and inform treatment decisions.
authors.affiliation: Epidemic Intelligence Service,Centers for Disease Control and Prevention,Atlanta, GA,USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Joseph
authors.affiliation: Infectious Diseases Section,Sharp Grossmont Hospital,La Mesa, CA,USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Haddad
authors.affiliation: Billings Clinic,Billings, MT,USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Matthews
authors.affiliation: County of San Diego Health and Human Services Agency,San Diego, CA,USA.
authors.forename: A
authors.initials: A
authors.lastname: Maroufi
authors.affiliation: Poxvirus Branch, National Center for Emerging, Zoonotic and Infectious Diseases,Centers for Disease Control and Prevention,Atlanta, GA,USA.
authors.forename: B
authors.initials: B
authors.lastname: Monroe
authors.affiliation: Poxvirus Branch, National Center for Emerging, Zoonotic and Infectious Diseases,Centers for Disease Control and Prevention,Atlanta, GA,USA.
authors.forename: M
authors.initials: M
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D000818:Animals; D004474:Ecthyma, Contagious; D004892:Erythema Multiforme; D005076:Exanthema / Q000473:pathology / Q000821:virology; D005260:Female; D006225:Hand / Q000473:pathology / Q000821:virology; D006801:Humans; D008297:Male; D009923:Orf virus / Q000302:isolation & purification*; D012756:Sheep; D012867:Skin / Q000473:pathology / Q000821:virology; D015047:Zoonoses