Progressive vaccinia: case description and laboratory-guided therapy with vaccinia immune globulin, ST-246, and CMX001.
Progressive vaccinia (PV) is a rare but potentially lethal complication that develops in smallpox vaccine recipients with severely impaired cellular immunity. We describe a patient with PV who required treatment with vaccinia immune globulin and who received 2 investigational agents, ST-246 and CMX001. We describe the various molecular, pharmacokinetic, and immunologic studies that provided guidance to escalate and then successfully discontinue therapy. Despite development of resistance to ST-246 during treatment, the patient had resolution of PV. This case demonstrates the need for continued development of novel anti-orthopoxvirus pharmaceuticals and the importance of both intensive and timely clinical and laboratory support in management of PV.
National Center for Zoonotic Vector Borne and Enteric Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA. erlederman@yahoo.com
Edith R
ER
Lederman
Whitni
W
Davidson
Harold L
HL
Groff
Scott K
SK
Smith
Tyler
T
Warkentien
Yu
Y
Li
Kimberly A
KA
Wilkins
Kevin L
KL
Karem
Rama S
RS
Akondy
Rafi
R
Ahmed
Michael
M
Frace
Wun-Ju
WJ
Shieh
Sherif
S
Zaki
Dennis E
DE
Hruby
Wendy P
WP
Painter
Kimberly L
KL
Bergman
Jeffrey I
JI
Cohen
Inger K
IK
Damon
D000328:Adult; D000914:Antibodies, Viral / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001549:Benzamides / Q000008:administration & dosage*; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D024882:Drug Resistance, Viral; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D054833:Isoindoles / Q000008:administration & dosage*; D008297:Male; D063065:Organophosphonates / Q000008:administration & dosage*; D012900:Smallpox Vaccine / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014615:Vaccinia / Q000175:diagnosis* / Q000188:drug therapy*; D014616:Vaccinia virus / Q000302:isolation & purification*; D010797:Phthalimides
D000914:Antibodies, Viral; D000998:Antiviral Agents; D001549:Benzamides; D003596:Cytosine; D007136:Immunoglobulins; D054833:Isoindoles; D063065:Organophosphonates; D012900:Smallpox Vaccine; C525733:brincidofovir; C505045:tecovirimat; D010797:Phthalimides