Generalized Vaccinia in a Patient with Chronic Lymphocytic Leukemia and Hypogammaglobulinemia

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Abstract
The patient, a 65-year-old woman, was first seen in 1959 with the diagnosis of chronic lymphocytic leukemia. In 1963, the patient received a smallpox vaccination. She had been vaccinated in childhood and more recently was revaccinated in 1947 and 1957 with a normal accelerated response. Forty-eight hours after vaccination, the patient became acutely ill with high fever, weakness, anorexia, lassitude, cough, and coryza. Over the next two weeks, she developed marked swelling of her left upper arm and an eruption over the buttock characterized by papules, vesicles, pustules, and superficial ulcers in various stages of development. The diagnosis of generalized vaccinia was made. The patient responded to bacitracin ointment, and the vaccinia resolved over the next four weeks. Studied in patients with chronic lymphocytic leukemia and acquired hypogammaglobulinemia indicate an immunologic defect very similar to that described in infants with agammaglobulinemia. The majority of these patients are particularly susceptible to bacterial infections and less susceptible to viral infections, except for herpes zoster and viral hepatitis. Although vaccination is generally considered an innocuous procedure, the evidence presented suggests that patients with defective immune responsiveness may suffer serious consequences.