Contagious Ecthyma

A 34-year-old farmer presented with a painful rash on his left hand. The rash began a few days after a sheep bit his hand while being bolus-fed. The patient was experienced in sheep care and reported that multiple animals on his farm had “sore mouth disease.” A 34-year-old farmer presented to our emergency department with a painful rash with purulent-appearing papules on his hands (Panels A and B). The rash had been worsening over the previous 2 1 / 2 weeks. The physical examination was otherwise unremarkable. The patient manages livestock on his farm. The rash began a few days after a sheep bit his left hand while being bolus-fed. The patient was experienced in sheep care and reported that multiple animals on his farm had “sore mouth disease.” He did not wear gloves while performing the feeds. Initial differential diagnosis included herpetic whitlow, cutaneous anthrax, methicillin-resistant . . .