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Image Number 4821 (Orf and erythema multiforme)


Diagnosis: Orf and erythema multiforme

Site: Finger

Sex: F

Age: 44


Description: Painful nodule.

Submitted by: Nameer Al-Sudany

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Differential Diagnosis


 A 44-year-old housewife woman presented with a solitary painful targetoid plaque/nodules on the he thumb of 2 weeks duration.  She was diagnosed as ORF and treated with a topical antibiotic ointment and NSAID. However, three days later she returned back with fever, increasing pain and extended tender erythematous swelling around the original lesion. She was diagnosed as cellulitis complicating Orf in spite of topical antibiotic previously prescribed! Cefotaxime 1 gm i.m daily was prescribed for 5 days but after two injections she presented with red papular rash on the extreimities and face and minimally on the trunk and she thought it was due to drug allergy! Anyhow, on examination typical iris-like lesions were evident, so it was diagnosed as Orf-associated EM rather than drug induced EM by the virtue that association of EM with Orf is commoner than drug induced EM (Cefotaxime!). Topical CS for EM rash and oral anthistaminics were given with very good improvement with 7-10 days.

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