Milker‘s Nodule (Pseudocowpox) in a Female Patient Following a Calf Bite

Figure

A 48-year-old female patient presented with two erythematous, mildly painful nodules on the thumb. These had developed within 3 weeks of the uncomplicated resolution of two wounds following a bite from a calf. Using polymerase chain reaction, parapoxviruses were detected in the cloudy puncture specimen. These viruses cause, as in this case, milker‘s nodules transmitted by cows (paravaccinia virus) and orf/ecthyma contagiosum (orf virus) transmitted by sheep and goats. Both diseases follow a similar course, are found worldwide, and are transmitted either directly from infected animals or indirectly via environmental contamination to epidermal skin lesions, where they typically cause maculopapular skin lesions. These heal without treatment and scarring within approximately 2 months, as was the case in our patient. Nevertheless, it is important to be aware of these benign disorders in order to be able to distinguish them in the differential diagnosis from diseases requiring treatment, such as tularemia and anthrax, which have similar clinical presentations. Furthermore, immunosuppressed individuals may experience a severe course of the disease. A high incidence of these infections is seen every year during Eid al-Adha, the Islamic feast of sacrifice.

Dorian Marckmann, Dr. med. univ. Andreas Frasnelli, Spitalzentrum Oberwallis, Visp, Schweiz, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye

Cite this as: Marckmann D, Frasnelli A: Milker‘s nodule (pseudocowpox) in a female patient following a calf bite. Dtsch Arztebl Int 2020; 117: 870. DOI: 10.3238/arztebl.2020.0870b