Genital orf

A man in his early 40s presented with extensive skin lesions in the groin and genital regions. The lesions were erythematous and maculopapular but evolved into vesicles and pustules with surrounding cellulitis. He stated that he grips livestock between his legs for sheep shearing. Inflammatory markers were high, and skin swab cultures grew mixed bacteria. There was no evidence of necrotising soft tissue infection. Skin biopsy demonstrated irregularly acanthotic epidermis, striking reticular degeneration with intraepidermal oedema and surface necrosis. Keratinocytes displayed ballooning degeneration, with many showing vacuolation and eosinophilic cytoplasmic inclusions. There was no granulomatous infiltrate to suggest an atypical mycobacterial infection. Viral specimens sent for PCR confirmed orf virus infection. Though the treatment of orf is conservative, he was treated with parenteral antibiotics and topical antiseptics for secondary bacterial infection. Genital orf should be considered when clinically suggestive and eliciting detailed occupational and contact history is crucial in diagnosis.