Gegeneraliseerde orf-super-infectie bij atopisch eczeem

During an exacerbation of atopic dermatitis (AD), a 15-year-old boy presented with a generalized orf superinfection. This infection was subsequently complicated by oral erythema multiforme. Although viral superinfections in AD, for example eczema herpeticum, are frequently described a generalized orf infection is extremely rare. In humans orf usually manifests as a solitary ulcerative nod(ul)e on the hands or forearms (ecthyma contagiosum), which develops after contact with infected sheep or goats. A classic clinical presentation of an orf infection can be affected by dysregulation of both innate and adaptive immunity. This can deteriorate in a generalized infection, caused by the orf virus, expressing a range of immunoregulatory proteins. The main factors in an immunological dysregulation are a disturbed epithelial barrier and overexpression of TH2-associated cytokines en subsequent suppression of the TH1-associated immune response. Although a generalized orf infection is a troublesome skin disease, therapeutic intervention in immunocompetent individuals is not indicated.