Answer
Vaccinia of the eyelid caused by inadvertent inoculation: Vaccinia virus is the live virus used in the smallpox vaccine. It is a pox-type virus related to smallpox. When given to humans as a vaccine, it helps the body develop immunity to smallpox. Because the virus in the vaccine is live, it can be inadvertently transmitted from the recently vaccinated person to other people. Bandages, clothing, and hands that touch the vaccination site before it heals can become contaminated and transmit the virus to another person. Care of the vaccination site must be taken to prevent spreading of the vaccinia virus.
Treatment of this patient involves consultation with an ophthalmologist to assess the eye and the administration of vaccinia immunoglobulin (VIG) together with systemic antibiotics to prevent and treat any secondary bacterial infection. The differential diagnosis includes primary herpes simplex infection of the eyelid; however, in this case, the recent history of a family member being vaccinated against smallpox confirms the diagnosis of vaccinia.
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BACKGROUND
A 7-year-old boy presents to his primary care physician with a swollen left eye. Three days ago, what was thought to be a pimple developed below his left eye, adjacent to his nose. Two days ago, the left eyelids appeared erythematous and swollen. Yesterday, the swelling became worse, and the patient's mother noted discharge from his left eye. In addition, he had a low-grade fever and complained of having a headache and body aches. What is the diagnosis?
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Hint
The patient's father is in the US Army Special Forces and is being deployed to Iraq next week.
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Author:
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Andrew A. Dahl, MD
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Vassar Brothers Hospital
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eMedicine Editor:
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Hampton Roy Sr, MD
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University of Arkansas for Medical Sciences
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eMedicine
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