Orf disease in a patient with rheumatoid arthritis.

Orf disease is a viral infection, affecting patients being involved in the care of livestock either professionally or habitually. It is also known as ecthyma contagious, contagious pustular dermatitis or infectious euphoria being a rare zoonotic disease caused by an epitheliotropic DNA virus from the parapoxvirus group. We report a case of Orf disease affecting the hand of a patient with rheumatoid arthritis (RA) on treatment with methotrexate and adalimumab, an anti-tumor necrosis factor biological agent. The patient was successfully treated with doxycycline, while immunosuppressive treatment was discontinued.

Anti-synthetase syndrome presenting with interstitial lung disease.

Anti-synthetase syndrome is an idiopathic inflammatory myopathy characterized by interstitial lung involvement, arthritis, Raynaud's phenomenon, mechanic's hands and fever. The case of anti-synthetase syndrome in a young female is reported. The patient presented with interstitial lung disease, initially subclinical muscle involvement, Raynaud's phenomenon, arthritis and mechanic's hands. Induction therapy was administrated, that consisted of intravenous methylprednisolone and cyclophosphamide, followed by azathioprine and prednisone with good response, and finally, complete remission. The presence of mechanic's hands in a patient with lung involvement should prompt for specific investigations such as anti-synthetase antibodies and muscle enzymes. Anti-synthetase syndrome should be aggressively managed by immunosuppressive therapy, as interstitial lung disease is a severe manifestation of the disease which may affect quality of life and life expectancy.