title: Isolation of vaccinia JX594 from pustules following therapy for hepatocellular carcinoma.
abstract: BACKGROUND
  JX594 is an oncolytic poxvirus derived from Wyeth strain vaccinia virus. We reported the presentation of cutaneous and mucosal pustules containing laboratory-confirmed JX594 in a patient following injection of JX594.
  
  
  METHODS
  A 36-year-old man was diagnosed hepatitis B virus-associated hepatocellular carcinoma on September 19, 2011. Despite treatment with entecavir, radiofrequency ablation and transarterial chemoembolization for recurrent local tumors, the tumors recurred in both lobes and lung metastases were detected by computed tomography on September 12, 2012. The patient was treated with JX594 (Pexa-vec®) via intravenous injection on December 19, 2012. No apparent adverse effects were observed following intravenous injection other than a single fever episode. However, pustular lesions were detected on both sides of the tongue dorsum and on the proximal interphalangeal joint of the right middle finger on December 25, 1012. Biopsy samples analyzed by PCR identified the presence of the JX-594-specific hGM-CSF transgene and the disrupted viral thymidine kinase gene. Following aspiration of the lesion a scab formed that resolved within 14 days without necessitating additional treatment.
  
  
  CONCLUSIONS
  Our case completely recovered and did not develop systemic or recurrent disease, the presentation of a few pustules may not necessarily require that treatment with JX594 be interrupted for patients with advanced hepatocellular carcinoma.
authors.affiliation: Division of Infectious Diseases, Department of medicine, Taipei Veterans General Hospital, Taipei, Taiwan. timchk@gmail.com.|Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan. timchk@gmail.com.
authors.forename: Che-Hsuan
authors.initials: CH
authors.lastname: Kung
authors.affiliation: Division of Infectious Diseases, Department of medicine, Taipei Veterans General Hospital, Taipei, Taiwan. ludwigvantw@gmail.com.|Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. ludwigvantw@gmail.com.|National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan. ludwigvantw@gmail.com.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan. tecklayyy@gmail.com.|Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. tecklayyy@gmail.com.
authors.forename: Te-Li
authors.initials: TL
authors.lastname: Chen
authors.affiliation: Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. wengwensung@gmail.com.
authors.forename: Wen-Sung
authors.initials: WS
authors.lastname: Weng
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000235:genetics / Q000628:therapy* / Q000821:virology; D006515:Hepatitis B virus / Q000472:pathogenicity; D006801:Humans; D008113:Liver Neoplasms / Q000235:genetics / Q000628:therapy* / Q000821:virology; D008297:Male; D050130:Oncolytic Virotherapy / Q000379:methods; D050504:Oncolytic Viruses / Q000235:genetics*; D011212:Poxviridae / Q000235:genetics*; D013937:Thymidine Kinase / Q000235:genetics; D014615:Vaccinia / Q000473:pathology / Q000821:virology; D014616:Vaccinia virus / Q000235:genetics
chemical_list: D013937:Thymidine Kinase