Vaccinia Gangrenosa

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Abstract
The 3rd case of vaccinia gangrenosa occurring in an adult is reported. Rarest and most serious of the complications of smallpox vaccination, the disease is characterized by progressive spread and necrosis of the primary inoculation site, metastatic vaccinial lesions, and a uniformly fatal outcome when not specifically treated. In each of the 7 reported cases, including the present one, in which conclusive studies were performed, antibody response to the vaccinia virus was found to be lacking, and this would appear to be essential in the pathogenesis of the infection. The patient in the present case had unerlying chronic lymphatic leukemia, as did one of the two other adult cases previously reported. This is presumably due to the hypogammaglobulinemia and depressed antibody responsiveness not infrequently associated with this condition. The other entity frequently present in cases of vaccinia gangrenosa is idiopathic hypogammaglobulinemia. This case is the 3rd to be reported in which the patient recovered from the disease. He was treated with hyperimmune vaccinial gamma globulin and hyperimmune vaccinial whole blood. These appear to be the only effective therapeutic agents.
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