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Author: Assoc Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand, 2013.
Biopsy of a classic fully developed farmyard pox papulovesicle exhibits an intraepidermal blister secondary to massive ballooning of infected keratocytes and subsequent necrosis (figure 1). Necrosis and acute spongiosis often accompany ballooning (figure 2). The intranuclear inclusions are eosinophilic and may be exceedingly difficult to find (figure 3, arrow). Often, the reaction pattern, necrosis and ballooning keratinocyte degeneration are the only clues and a clinical history of exposure to farm animals together with ancillary studies may lead to the correct diagnosis.
The farmyard pox inclusion bodies may be highlighted by Lendrum’s phloxine tartazine.
Culture, fluorescent antibody test, and electron microscopy may be used to demonstrate the causative pox virus.
Cowpox, horsepox and smallpox – These also exhibit impressive ballooning of keratocytes, necrosis and inclusion bodies which may resemble those seen in farmyard pox. Clinical history and – if necessary – ancillary microbiologic investigations may be required for precise diagnosis.
Herpes simplex, varicella, and zoster – The viral inclusions are distinctively different.
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