Photo Quiz; Anthrax or Orf?

Abstract

A 38-year-old man presented to the hospital with complaints of fever and multiple lesions on his face, hands, and arms. The lesions were appeared five days earlier before admission as painless small papules and developed into larger lesions with the darkish center. He was experiencing a fever for the last 24 hours. He was a farmer, he sacrificed and butchered a bull at the Eid al-Adha, ten days ago. He reported that he was healthy previously and did not use any drug. On physical examination, his body temperature was 39°C. He had multiple lesions on arms, hands, face and erythematous diffuse edema on his right hand, on 4th finger extending to the arm. There were some satellite lesions on the left arm (Figure1, 2), as well. He had a red lymphangitic streak on the right arm that extended from the hands toward the axillae with a palpable and tender axillary lymph node 2 cm in diameter. Laboratory examination revealed white blood count 11600 cells/μL with left shift, and C-reactive protein 85 mg/ dL (N: 0-5). Aspiration material was obtained from the lesion on the 4th finger, stained with Gram stain and cultured.