Severe eczema vaccinatum in a household contact of a smallpox vaccinee.
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.
Vora
Surabhi
S
Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois 60637, USA. sbhargav@uchicago.edu
Damon
Inger
I
Fulginiti
Vincent
V
Weber
Stephen G
SG
Kahana
Madelyn
M
Stein
Sarah L
SL
Gerber
Susan I
SI
Garcia-Houchins
Sylvia
S
Lederman
Edith
E
Hruby
Dennis
D
Collins
Limone
L
Scott
Dorothy
D
Thompson
Kenneth
K
Barson
John V
JV
Regnery
Russell
R
Hughes
Christine
C
Daum
Robert S
RS
Li
Yu
Y
Zhao
Hui
H
Smith
Scott
S
Braden
Zach
Z
Karem
Kevin
K
Olson
Victoria
V
Davidson
Whitni
W
Trindade
Giliane
G
Bolken
Tove
T
Jordan
Robert
R
Tien
Debbie
D
Marcinak
John
J
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
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