Progressive vaccinia

Progressive vaccinia
Progressive vaccinia
Other names	Vaccinia gangrenosum, Vaccinia necrosum or disseminated vaccinia
	The patient required a skin graft on her upper left arm in order to correct the necrotic vaccination site, due to the onset of progressive vaccinia, formerly known as vaccinia gangrenosum.
Specialty	Dermatology
Symptoms	Malaise, fever, vomiting and tender, enlarged axillary lymph nodes; progresses to septic Pseudomonas aeruginosa, likely from a perirectal abscess, Clostridioides difficile (bacteria), Staphylococcus aureus and cell-mediated immunodeficiency.
Complications	Necrosis of the injected part, exacerbating to gangrene and eventual amputation. Usually, the pocks tend to go away without scarring; however, the external and internal spread of the virus may have serious consequences in persons with eczema and other forms of atopic dermatitis, in these persons, defects of innate immunity and a high level of Th2 cell activity render the skin unusually permissive to the initiation and rapid spread of vaccinia infection (known as “eczema vaccinatum”)
Usual onset	11 days to 6.5 weeks
Duration	Long-lasting
Causes	Injection by the vaccinia virus (genus: orthopoxvirus) as a countermeasure for smallpox
Risk factors	People with cellular immunodeficiencies
Diagnostic method	Fever and headache, then progressive ulceration and necrosis of the injection site for smallpox, albeit the lack of inflammation is noted as the "hallmark of PV"
Differential diagnosis	May initially be mistaken for leukemia
Prevention	Unknown
Treatment	Vaccinia Immune Globulin Intravenous (Human) (VIGIV), Emergency Investigational New Drug (E-IND) both administered orally and topically, (in this case ST-246); CMX001, a lipid conjugate of cidofovir and granulocyte colony-stimulating factor for the exiguous normal white blood cells;supportive care; skin graft
Medication	Imiquimod, and thiosemicarbazone
Prognosis	Lifelong
Frequency	every 1 or 2 in a million during routine vaccination during 1963-1968 for smallpox
Deaths	fatality rate: 15%

Progressive vaccinia is a rare cutaneous condition caused by the vaccinia virus, characterized by painless but progressive necrosis and ulceration.

Progressive vaccinia
Other names	Vaccinia gangrenosum, Vaccinia necrosum or disseminated vaccinia

The patient required a skin graft on her upper left arm in order to correct the necrotic vaccination site, due to the onset of progressive vaccinia, formerly known as vaccinia gangrenosum.
Specialty	Dermatology
Symptoms	Malaise, fever, vomiting and tender, enlarged axillary lymph nodes; progresses to septic Pseudomonas aeruginosa, likely from a perirectal abscess, Clostridioides difficile (bacteria), Staphylococcus aureus and cell-mediated immunodeficiency.
Complications	Necrosis of the injected part, exacerbating to gangrene and eventual amputation. Usually, the pocks tend to go away without scarring; however, the external and internal spread of the virus may have serious consequences in persons with eczema and other forms of atopic dermatitis, in these persons, defects of innate immunity and a high level of Th2 cell activity render the skin unusually permissive to the initiation and rapid spread of vaccinia infection (known as “eczema vaccinatum”)
Usual onset	11 days to 6.5 weeks
Duration	Long-lasting
Causes	Injection by the vaccinia virus (genus: orthopoxvirus) as a countermeasure for smallpox
Risk factors	People with cellular immunodeficiencies
Diagnostic method	Fever and headache, then progressive ulceration and necrosis of the injection site for smallpox, albeit the lack of inflammation is noted as the "hallmark of PV"
Differential diagnosis	May initially be mistaken for leukemia
Prevention	Unknown
Treatment	Vaccinia Immune Globulin Intravenous (Human) (VIGIV), Emergency Investigational New Drug (E-IND) both administered orally and topically, (in this case ST-246); CMX001, a lipid conjugate of cidofovir and granulocyte colony-stimulating factor for the exiguous normal white blood cells;supportive care; skin graft
Medication	Imiquimod, and thiosemicarbazone
Prognosis	Lifelong
Frequency	every 1 or 2 in a million during routine vaccination during 1963-1968 for smallpox
Deaths	fatality rate: 15%