title: Severe eczema vaccinatum in a household contact of a smallpox vaccinee.
abstract: BACKGROUND
  We report the first confirmed case of eczema vaccinatum in the United States related to smallpox vaccination since routine vaccination was discontinued in 1972. A 28-month-old child with refractory atopic dermatitis developed eczema vaccinatum after exposure to his father, a member of the US military who had recently received smallpox vaccine. The father had a history of inactive eczema but reportedly reacted normally to the vaccine. The child's mother also developed contact vaccinia infection.
  
  
  METHODS
  Treatment of the child included vaccinia immune globulin administered intravenously, used for the first time in a pediatric patient; cidofovir, never previously used for human vaccinia infection; and ST-246, an investigational agent being studied for the treatment of orthopoxvirus infection. Serological response to vaccinia virus and viral DNA levels, correlated with clinical events, were utilized to monitor the course of disease and to guide therapy. Burn patient-type management was required, including skin grafts.
  
  
  RESULTS
  The child was discharged from the hospital after 48 days and has recovered with no apparent systemic sequelae or significant scarring.
  
  
  CONCLUSIONS
  This case illustrates the need for careful screening prior to administration of smallpox vaccine and awareness by clinicians of the ongoing vaccination program and the potential risk for severe adverse events related to vaccinia virus.
authors.affiliation: Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois 60637, USA. sbhargav@uchicago.edu
authors.forename: Surabhi
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authors.lastname: Damon
authors.forename: Vincent
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authors.forename: Susan I
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authors.forename: Edith
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authors.lastname: Lederman
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authors.forename: Dorothy
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authors.lastname: Scott
authors.forename: Kenneth
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authors.lastname: Thompson
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authors.lastname: Hughes
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authors.forename: Hui
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authors.lastname: Zhao
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authors.lastname: Smith
authors.forename: Zach
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authors.lastname: Braden
authors.forename: Kevin
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authors.lastname: Karem
authors.forename: Victoria
authors.initials: V
authors.lastname: Olson
authors.forename: Whitni
authors.initials: W
authors.lastname: Davidson
authors.forename: Giliane
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authors.lastname: Trindade
authors.forename: Tove
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authors.lastname: Bolken
authors.forename: Robert
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authors.lastname: Jordan
authors.forename: Debbie
authors.initials: D
authors.lastname: Tien
authors.forename: John
authors.initials: J
authors.lastname: Marcinak
mesh_terms: D000914:Antibodies, Viral / Q000097:blood / Q000627:therapeutic use; D001549:Benzamides / Q000627:therapeutic use; D002675:Child, Preschool; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood; D003876:Dermatitis, Atopic / Q000150:complications; D005192:Family Health; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D054833:Isoindoles / Q000627:therapeutic use; D007617:Kaposi Varicelliform Eruption / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use; D010949:Plasma / Q000737:chemistry; D016038:Skin Transplantation; D012900:Smallpox Vaccine; D014481:United States; D010797:Phthalimides
chemical_list: D000914:Antibodies, Viral; D001549:Benzamides; D000077404:Cidofovir; D003596:Cytosine; D004279:DNA, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D016756:Immunoglobulins, Intravenous; D054833:Isoindoles; D063065:Organophosphonates; D012900:Smallpox Vaccine; C505045:tecovirimat; D010797:Phthalimides