As the World Health Organization (WHO) had declared the eradication of smallpox in 1979 after successful global immunization, the use of vaccinia virus in the prophylaxis of humans was not carried out until the beginning of the 21st century, when smallpox was considered to be a possible biological weapon [1] [2]. Consequently, the United States and several other countries have reintroduced vaccination of military personnel and certain at-risk individuals, which led to reports of various complications and adverse reactions, one of them being eczema vaccinatum [1] [2] [3] [4]. Although seen only in a handful of cases, patients develop eczema vaccinatum shortly after vaccination or after direct contact with recently vaccinated individuals [1] [2] [3] [5] [7]. Studies have confirmed that the main predisposing factor (and a contraindication) for this cutaneous disorder is the presence of atopic dermatitis (or some other type of dermatitis) [1] [2] [4] [5] [6]. The abrupt onset of vesicles, pustules, and erosions in same stages approximately 3-14 days after being in contact with the vaccinia virus is the hallmark of eczema vaccinatum [2]. Lesions that are seen on the skin are commonly superinfected (predominantly by Staphylococcus aureus), while corneal lesions may also develop, potentially leading to corneal ulceration and even blindness [2]. Furthermore, fever, lymphadenopathy, and malaise can accompany skin lesions [2]. In addition to cutaneous and ocular disorders, life-threatening subglottic edema is a possible complication [2], implying that early recognition is vital.

• Fever

  The appearance of vesicles and pustules, as well as systemic symptoms such as fever and malaise, constitute the clinical presentation. Clinical and microbiological studies are needed to make the diagnosis. [symptoma.com]

  Vaccinatum 2 3 4 5 Progressive Vaccinia 6 7 Enlarged Site vs PV Large Reaction Differentiation 8 Enlarged Site vs PV Large Reaction Differentiation 9 Progressive Vaccinia 10 Post-Vaccinial Encephalitis Diagnosis Cerebral or cerebellar dysfunction Headache Fever [slideplayer.com]

  Princeton's WordNet (0.00 / 0 votes) Rate this definition: eczema vaccinatum, Kaposi's varicelliform eruption (noun) a now rare complication of vaccinia superimposed on atopic dermatitis with high fever and generalized vesicles and papulovesicles Freebase [definitions.net]

  Persons suffering from childhood eczema may develop another allergic condition later, most often hay fever or asthma. Cause and Treatment. Eczema is sometimes caused by an allergic sensitivity to foods such as milk, fish, or eggs. [medical-dictionary.thefreedictionary.com]

• Vietnamese

  Русский (Russian) ಕನ್ನಡ (Kannada) 한국어 (Korean) עברית (Hebrew) Український (Ukrainian) اردو (Urdu) Magyar (Hungarian) मानक हिन्दी (Hindi) Indonesia (Indonesian) Italiano (Italian) தமிழ் (Tamil) Türkçe (Turkish) తెలుగు (Telugu) ภาษาไทย (Thai) Tiếng Việt (Vietnamese [definitions.net]

• Scaly Rash

  A itchy, red, scaly rash lasting over 2 wks? Vaccinia immune globulin ( VIG ): only available from CDC but considered experimental, so needs IND protocol: T (404) 639-3356 EV is clear indication for urgent use. Early treatment may be life-saving. [hopkinsguides.com]

• Exanthema

  References Infectious skin disease: Viral cutaneous conditions, including viral exanthema (B00–B09, 050–059) DNA virus Herpesviridae Alpha HSV (Herpes simplex, Herpetic whitlow, Herpes gladiatorum, Herpetic keratoconjunctivitis, Herpetic sycosis, Neonatal [dictionnaire.sensagent.leparisien.fr]

• Angioedema

  Adverse reaction to cytokines · Bromoderma · Halogenoderma · Iododerma · Red man syndrome · Methotrexate-induced papular eruption unspecified agent: Acute generalized exanthematous pustulosis · Bullous drug reaction · Drug-induced acne · Drug-induced angioedema [dictionnaire.sensagent.leparisien.fr]

• Facial Edema

  Figure 1 Ten days after being vaccinated against smallpox, a 27-year-old man was hospitalized with a high fever, facial edema, and an umbilicated, vesicular, crusting rash on his face, neck, upper chest, and hands (Panel A). [nejm.org]

Given the rare occurrence of eczema vaccinatum in clinical practice, the diagnosis may not be easy. For this reason, physicians must obtain a thorough patient history that will assess the course and progression of symptoms, the presence of preexisting skin diseases, and if family members or close relatives/friends (or the patient him/herself) have been recently vaccinated for smallpox. As military personnel are predominantly mentioned in the reports [1] [2] [4], the patient's occupation (or their parents') should be evaluated. A detailed physical examination is equally important, as the abrupt onset of typical lesions has a very narrow differential diagnosis. Microbiological studies, however, are necessary to confirm eczema vaccinatum. Molecular methods that detect viral genetic material - polymerase chain reaction (PCR) are recommended tests for identifying vaccinia virus in skin biopsy samples, swabs from the lesions or from the skin of an open vesicle [1] [2]. Moreover, the specific finding of Guarnieri bodies (intracytoplasmic inclusions) on histological examination is useful in making the diagnosis [2]. Thus, a microbiological investigation should be initiated as soon as clinical suspicion is raised.

1. Vora S, Damon I, Fulginiti V, et al. Severe eczema vaccinatum in a household contact of a smallpox vaccinee. Clin Infect Dis. 2008;46(10):1555-1561.
2. Jen M, Chang MW. Eczema herpeticum and eczema vaccinatum in children. Pediatr Ann. 2010;39(10):658-664.
3. Moses AE, Cohen-Poradosu R. Images in clinical medicine. Eczema vaccinatum--a timely reminder. N Engl J Med. 2002;346(17):1287.
4. Reed JL, Scott DE, Bray M. Eczema vaccinatum. Clin Infect Dis. 2012;54(6):832-840.
5. Vellozzi C, Lane JM, Averhoff F, et al. Generalized vaccinia, progressive vaccinia, and eczema vaccinatum are rare following smallpox (vaccinia) vaccination: United States surveillance, 2003. Clin Infect Dis. 2005;41(5):689-697.
6. Cono J, Casey C, Bell D. Smallpox vaccination and adverse reactions. Guidance for clinicians. MMWR Recomm Rep. 2003;52(RR-4):1–28.
7. Herderson DA. Smallpox vaccination: a review, part II: adverse events, Clin Infect Dis. 2003;37:251-271.