"Goat eyes": Horizontal rectangular pupils: An unusual clinical presentation of orf

Enver Turan¹ , Sila Seremet²

¹ Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey
² Department of Dermatology, Katip Çelebi University, Ataturk Training and Research Hospital, Izmir, Turkey

Correspondence Address:
Enver Turan
Department of Dermatology, Harran University School of Medicine, 63300-Sanliurfa
Turkey

Sir,

Orf, also known as ecthyma contagiosum or contagious pustular dermatitis is a zoonotic viral disease caused by contact of damaged skin with infected animals, directly or indirectly. The pathogenic agent is an epitheliotropic DNA virus from the parapoxvirus family and affects sheep, goats, and other domestic or wild ruminants. ^[1],[2] In humans, it generally presents as an "iris-like shaped" solitary skin lesion, but may rarely have an unusual form or shape. ^[3],[4] Here, we share a new dermatologic finding for orf. We were unable to find any previous reports of this clinical sign.

A 33-year-old woman presented to our dermatology clinic with multiple lesions on her fingers that appeared after she incurred an injury 3 weeks ago while engaging in ovine slaughter. During this period, the lesions became larger and evolved into erythematous nodules involving centrally located horizontal rectangular iris-shaped areas. The patient had no subjective complaints and was otherwise healthy. Dermatologic examination of the lesion showed the following findings, from outside inwards: an outermost light yellow round rim that was paler than normal skin, an outer erythematous violaceous ring, a middle thin purple ring, an inner pale-whitish central round area and a central fawn-colored brown horizontal rectangular area [Figure - 1].

Figure 1: Multiple orf lesions on the hands showing horizontal, rectangular, iris-shaped areas at the centre

Gram′s and Giemsa stained smear preparations and wound culture failed to reveal evidence of a pathologic micro-organism. A 5-mm punch biopsy showed partial cytoplasmic vacuolisation and several cells with eosinophilic intranuclear and intracytoplasmic inclusion bodies in the stratum spinosum layer of the stratified squamous epithelium. The clinical and histopathologic findings indicated ecthyma contagiosum (orf). She was treated with wet dressings and a topical antibiotic cream. Weekly follow-up showed drying and shrinking of the lesions during the first week and complete healing after 5 weeks.

The typical lesion of orf presents with an initial erythematous macule. At the second stage, the macule evolves into a nodule with a central red center surrounded by a middle white ring, and an outer erythematous halo resembling a "bull′s eye". ^[5] Unlike this typical picture, the central part of the lesion in our patient had a horizontal rectangular shape resembling a "goat′s eye". Orf should be considered in the differential diagnosis for patients presenting with this unusual dermatological sign.

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