WIDESPREAD ECZEMA VACCINATUM ACQUIRED BY CONTACTS A Report of an Autopsy Case

Abstract

A 4-moth-old male infant predisposed to allergic dermatitis acquired widespread eczema vaccinatum by contacts with a recently vaccinated sibling. He died of acute purulent peritonitis following a perforation of multiple duodenal ulcers. Fluorescence immunocytochemical and electron microscopic studies on the skin lesions revealed the presence of viral antigens and numerous virus particles compatible morphologically with those of the mature form from the same batch of smallpox vaccine given to the sibling. A large number of virus particles in the developmental form were also predominantly scattered in the cytoplasm of cells at the stratum malpighii of the epidermis as well as in neutrophils and macrophages in the skin lesions. The virus isolation from the skin lesions was done by using the HeLa cells and the human embryonic lung fibroblasts. No abnormal laboratory data were noted in immunoglobulins. On the basis of atrophy of the thymus and other lymphatic tissues and an appearance of large pyroninophilic cells in association with blastoid transformation, the authors discussed a possible participation of the disturbance of cellular immunity secondary to the virus infection in the development of the disease. ACTA PATH. JAP. 29: 435-455, 1979.

Impaired immune response to vaccinia virus inoculated at the site of cutaneous allergic inflammation

“…Mortality may be as high as 6% in cases involving vaccinees, and as high as 4% in secondary cases. 4,5 Although smallpox vaccination is contraindicated in patients with atopic dermatitis (AD), they may develop EV after contact with a recently immunized individual, as has been documented lately in a child whose father had received the vaccine. 6 The immunologic basis of the enhanced susceptibility of patients with AD to EV is not well understood.…”