Sex: M
Vaccine: SMALL
Symptoms: Biopsy skin abnormal, Blister, Erythema, Genital lesion, Lichenoid keratosis
Clinical narrative: Initial unsolicited report received from the literature on 30-AUG-2017. This case was linked to: 2017SA165059, 2017SA165064, 2017SA165070 (same literature). The following is verbatim from the article: Abstract: Since 2003, the military has vaccinated troops for smallpox. In 2008, the military transitioned to the second-generation vaccine ACAM2000. Cutaneous adverse events associated with this vaccine are rarely characterized. We review the medical literature on cutaneous adverse events with ACAM2000 and describe four new cases that occurred at specific location in primary vaccinees. Four cases of disseminated papulovesicular lesions occurred out of 500 smallpox vaccinations given at specific location. Each case was followed by dermatology and preventive medicine. Biopsy specimens were examined at Medical Center and the Centers for Disease Control and Prevention. Three of the cases had variable clinical history of dermatitis. Case 1 experienced the most extensive lesions and case duration, and Case 4 the least. All biopsy sample results confirmed immune-mediated hypersensitivity. This study relied on self-reporting and on surveillance by unit medical staff to identify cases. Each case also received multiple other concurrent vaccinations. Further study is needed to increase our knowledge of these cutaneous reactions and demonstrate possible associated or causal factors. This case involves a 26-year-old male patient who was vaccinated with a dose of ACAM2000 (batch number, expiry date, dose, dose in series, site of administration were not reported) via percutaneous route on an unspecified date. The patient had a medical history of significant for a single episode of undiagnosed, pruritic dermatitis on his hands 2 years before, which resolved under conservative therapy without sequelae. No current medications or recent medical history were reported. On an unspecified date, few days following the vaccination (reported as 'patient presenting 17 days after vaccination'), the patient developing "burning pain" in his left thenar eminence a week before presenting and developing blisters in that area 3 to 4 days before presentation. On an unspecified date, following the vaccination, the patient's physical examination revealed approximately 40 bullae and intact vesicles 4 to 10 mm in size, with surrounding erythema, and some with central umbilication. Distribution included the right ear helix, left cheek, hands and arms bilaterally, chest, abdomen, and back and distal lower extremities bilaterally. There were also oral (right lateral tongue) and genital lesions. Body surface area involvement was estimated at less than 5 percentage. Over the hospitalization course, lesions spread to both ear helices, and increased in severity over dorsum more than palmar hand surfaces, extensor surfaces of elbows and knees, and lateral thighs. The patient complained of pruritus and oral pain. There were no constitutional symptoms. Patient's Viral PCR of lesions was negative for orthopox virus. MC dermatology read the biopsy specimens as lichenoid interface dermatitis. On an unspecified date, the patient was hospitalized. Other lab data was not reported. The patient received corrective treatment with unspecified supportive treatment, with no specific therapy. On an unspecified date, the patient recovered from the events (The lesions resolved over his 17-day hospitalization). Patient was determined as non-contagious, released from hospital. List of documents held by sender: none. Sender's Comments: Patient was diagnosed with Dermatitis lichenoid after vaccination. Time to onset is compatible with the role of vaccine. Laboratory investigations conducted confirm the diagnosis as well as patient has a medical history of pruritic dermatitis as well however, concomitant medications, previous vaccination and tolerance, laboratory investigations excluding other etiology would be needed to fully assess this case. Based on available information the role of vaccine cannot be evaluated.