title: Fatal disseminated cowpox virus infection in an adolescent renal transplant recipient.
abstract: A 17-year-old boy on long-term immunosuppression following renal transplantation for chronic kidney disease (CKD), the result of dysplastic kidneys, initially presented with a swelling in his neck while attending hospital for an unrelated problem. A clinical diagnosis of tonsillitis was made, and he was treated with broad-spectrum antibiotics. Over a few days, his condition deteriorated, and he developed multiple vesicopustular skin lesions and required an emergency tonsillectomy due to respiratory distress.
  
  
  
  Histological investigation of the skin and tonsillar tissue suggested a viral aetiology, and subsequent electron microscopy and polymerase chain reaction (PCR) tissue examination proved disseminated cowpox infection. The family cat, which was reported as having self-resolving sores on its skin, was likely the source of the infection. The child failed to respond to antiviral treatment and succumbed to multiorgan failure within a month of admission.
  
  
  
  We report this case of fatal disseminated cowpox infection to highlight an increasing risk of this illness in the post-transplant population and to detail some unusual features not previously described, such as tonsillar involvement, disseminated skin lesions and multiorgan failure.
authors: Dermatology Department, Birmingham Children's Hospital, Birmingham, UK. p.gazzani@nhs.net.
authors: Paul
authors: P
authors: Gazzani
authors: Dermatology Department, Birmingham Children's Hospital, Birmingham, UK.
authors: Joanna E
authors: JE
authors: Gach
authors: Histopathology Department, Birmingham Children's Hospital, Birmingham, UK.
authors: Isabel
authors: I
authors: Colmenero
authors: Intensive Care Department, Birmingham Children's Hospital, Birmingham, UK.
authors: Jeff
authors: J
authors: Martin
authors: Microbiology Department, Worcestershire Royal Hospital, Worcester, UK.
authors: Hugh
authors: H
authors: Morton
authors: Virus Reference Department, Public Health England, London, UK.
authors: Kevin
authors: K
authors: Brown
authors: Nephrology Department, Birmingham Children's Hospital, Birmingham, UK.
authors: David V
authors: DV
authors: Milford
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015605:Cowpox / Q000473:pathology / Q000821:virology*; D015608:Cowpox virus / Q000235:genetics; D017809:Fatal Outcome; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D016133:Polymerase Chain Reaction; D051436:Renal Insufficiency, Chronic / Q000601:surgery; D012871:Skin Diseases / Q000209:etiology / Q000821:virology; D014069:Tonsillitis / Q000188:drug therapy; D066027:Transplant Recipients
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cow pox; Fatal/death; Immunosuppression; Paediatric; Transplant