Milker's nodules

Last Updated: 2020-11-19

Author(s): Anzengruber F., Navarini A.

ICD11: -

Jenner 1798.

Paravacine nodes, milking pox.

Rare zoonosis of low infectivity caused by parapox virus.

  • Incubation period: 5-7 days.
  • Occurring on contact with cows.
  • Usually only the hands are affected.

Hemispherical, pea-sized, turgid, yellowish-brown knots with a blue-black tip. Locoregional lymphadenopathy.

Anamnesis, clinic, dermatopathology, electron microscopy (negative contrast), culture.

Vascular, epidermal granulation tissue with balloonized cells, multilocular vesicles.

  1. Adriano AR, Quiroz CD, Acosta ML, Jeunon T, Bonini F. Milker's nodule--Case report. An Bras Dermatol 2015;90:407-10.
  2.  Batalla A, Alvarez-Arguelles ME, Gonzalez-Martinez MB, Curto JR. [Milker's nodule complicated with erythema multiforme]. Med Clin (Barc) 2013;141:e5. 
  3. Henriques AM, Fagulha T, Duarte M, et al. Avian Poxvirus Infection in a Flamingo (Phoenicopterus Ruber) of the Lisbon Zoo. J Zoo Wildl Med 2016;47:161-74. 
  4. Osadebe LU, Manthiram K, McCollum AM, et al. Novel poxvirus infection in 2 patients from the United States. Clin Infect Dis 2015;60:195-202. 
  5. Novel poxvirus discovered in sea otters. J Am Vet Med Assoc 2014;245:265. 
  6. Werchniak AE, Herfort OP, Farrell TJ, Connolly KS, Baughman RD. Milker's nodule in a healthy young woman. Journal of the American Academy of Dermatology 2003;49:910-1. 
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