Sex: M
Vaccine: SMALL
Symptoms: Skin lesion, Total complement activity test, Type III immune complex mediated reaction, Urine analysis, Viral test negative
Clinical narrative: Initial unsolicited report received from the literature on 30-AUG-2017. This case was linked to: 2017SA163480, 2017SA165064, 2017SA165070 (same literature). The following is verbatim from the article: Abstract: Since 2003, the employer has vaccinated employees for smallpox. In 2008, the employer 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 in primary vaccinees. Four cases of disseminated papulovesicular lesions occurred out of 500 smallpox vaccinations given. 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 25-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 xerosis cutis on his hands, treated conservatively with over-the-counter moisturizers. The patient also reported having epidermal exposure to caustic cleaning chemicals during the week before presentation. No current medications or recent medical history were reported. On an unspecified date, few days following the vaccination, the patient developed burning pain in his upper extremities approximately 1 week before presentation, with subsequent development of vesicles in the affected areas. On an unspecified date, post vaccination, the patient had approximately 50 erythematous papules and vesicles on an erythematous base, approximately 3 to 6 mm in size. Some lesions demonstrated central umbilication. The lesions were most prominently distributed on the hands, with scattered lesions on the nose, neck, and upper torso. Over the hospitalization course, lesions spread to lips, ear helices, elbows, and extensor surfaces of knees and ankles. There were few palmar lesions. The patient complained of continued pruritus and occasional burning pain, which heralded locations for development of new lesions. There were no constitutional symptoms. It was also reported that on an unspecified date, following vaccination, the patient experienced immune-mediated hypersensitivity confirmed by biopsy. On an unspecified date, the patient was hospitalized. Lab data includes physical examination along with viral PCR of lesions was negative for orthopox virus. Dermatology read the biopsy specimens as spongiotic vesicular dermatitis with eosinophils and interface changes. Other tests performed are comprehensive metabolic panel, complete blood count, complement panel (complements C3 and C4), immune complement C1q binding, complement CH50 and urinalysis. It was reported that at least one punch or shave biopsy specimen was taken and examined. 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 10-day hospitalization). Patient was determined as non-contagious, released from hospital and returned to work. List of documents held by sender: none. Sender's Comments: A 25 year old male patient received ACAM2000 and experienced immune-mediated hypersensitivity reaction. Time to onset is compatible with the role of vaccine. The patient also had epidermal exposure to caustic cleaning chemicals during the week before presentation which could be the alternative cause of the event. Biopsy results demonstrated eosinophilic infiltration consistent with immune-mediated hypersensitivity reaction. Viral PCR of lesions was negative for orthopox virus. More details regarding patient's medical history, immune status, allergic test result and investigation reports are needed for fully assessment. Based on the available information role of vaccine cannot be excluded.