Vaccinina gangrenosa (vaccinia necrosum, progressive vaccinia) is a severe complication following vaccination with vaccinia virus.


The primary risk factor is some form of immunodeficiency (hypogammaglobulinemia, T-cell defect, HIV, immunosuppression, etc).


Clinical features:

(1) The patient is given the vaccinia vaccine.

(2) Secondary skin lesions appear to 6 to 14 days later and cover a large area.

(3) The patient develops systemic symptoms (fever, chills, etc) and appears toxic.

(4) The skin lesions may enlarge, ulcerate and become necrotic.

(5) The infection may follow a prolonged course.

(6) Multi-organ failure may occur.


The mortality rate may be high if the patient is not treated appropriately.


Therapy may entail:

(1) administration of hyperimmune antivaccinial gamma-globulin (if available)

(2) antiviral agents (such as methisazone).


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