[Orf Infection Localized in the Earlobe: The First Case Report in the Literature]

Orf is a zoonotic infection caused by the parapoxvirus belonging to the Poxviridae family. It is usually transmitted to humans from sheep and goats. Human-to-human transmission is quite rare. Shepherds, veterinarians, slaughterhouse workers and people living in rural areas who are in close contact with farm animals constitute the main risk group. It most commonly presents as pustular dermatitis on the hands, usually painless but sometimes associated with tenderness and pain in the early clinical stages. Auricular localization is quite rare, with a few cases involving the ear reported in the literature but earlobe involvement has not been previously reported. In this case report, a 14-year-old female patient who admitted with an erythematous, thick-walled pustular lesion on the right earlobe was presented. In the patient's history, there was close contact with sheep and especially newborn lambs. On physical examination, the lesion was observed to extend to the earring hole and had a fistulized appearance. Total surgical excision was performed under local anesthesia. Histopathological examination revealed proliferative inflammatory features as well as vacuolization and inclusion bodies consistent with viral infection. In molecular analysis, paraffin block-prepared samples were examined and the ORF-RPA gene region encoding the major component (RPO132) of the viral polymerase of the orf virus was amplified by polymerase chain reaction and a definite diagnosis was made. After surgical excision, no additional treatment was applied to the patient and she was followed up for six months with no recurrence or residual disease. Orf is generally a self-limiting infection; however, in atypical localizations it may show a rapidly growing course that mimics malignancy. In the differential diagnosis, especially cutaneous anthrax which is endemic in our country and monkeypox infections which have been reported in recent years, are of importance. In conclusion, it should be kept in mind that orf lesions may occur even in unexpected sites such as the periauricular region, particularly in patients living in rural areas with a history of animal contact. Early diagnosis of orf infection will prevent unnecessary aggressive surgical interventions and will also contribute to the proper follow-up of patients and the prevention of complications.