Skin lesions caused by Orthopoxvirus, cowpox - case report from Poland

Background:Despite the elimination of smallpox, other orthopoxviruses, including cowpox virus, still infect humans. Wild rodents are its natural reservoir. Infections in humans are commonly reported from contact with sick domestic cats, rarely directly from rats. Cow pox in humans is a rare zoonotic disease, the diagnosis of which is problematic due to its rarity and thus the lack of clinical experience.Case report:Presented with a summary of the available clinical data on a 15-year-old boy who became infected with cowpox by a domestic cat.The patient developed cutaneous macular changes in the facial area. Within 3 weeks of the onset of symptoms, the lesions progressed through the papular, vesicular and pustular stages before forming a hard black eschars (2 cm in diameter) with erythema and edema and regional lifadenopathy. Differential diagnosis consisting of cat scratch disease, anthrax and brucellosis excluded microbiological examination. The lesions left scars after 8 weeks of continuous topical antiseptic treatment.Conclusions:The clinical course may be complicated, and the improvement takes 4 to 8 weeks. Infection which entered through the skin changes was the cause of antibiotic therapy. Cowpox should be suspected in patients with poorly healing skin lesions accompanied by a painful black eschars with erythema and local lymphadenopathy.