Rapidly growing orf in a renal transplant recipient: favourable outcome with reduction of immunosuppression and imiquimod

Orf is a viral skin infection due to a poxvirus. It manifests as a nodule of the hands that heals spontaneously within 3–4 weeks, but may be persisting and difficult to treat in immunocompromised patients. Very few cases have been reported in transplant patients; therefore, management is not established. We report a renal transplant recipient with a rapidly growing orf which regressed after application of imiquimod and a reduction in immunosuppression without damage on his renal function. This case suggests that a rapidly growing orf in transplant patients behaves as an opportunistic infection and therefore minimization should be considered along with a topical treatment.