Smallpox vaccination has been associated with a number of rare, but clinically significant, complications including a wide variety of exanthems. Among these is vaccinia folliculitis, which typically coincides with the peak of viral replication at the vaccination site. Viable vaccinia virus has not been isolated from these lesions, which heal without scarring. We report a case of vaccinia folliculitis in a vaccinia-naive laboratory worker who subsequently developed swelling and violet discoloration of his hands and feet. Although vaccinia folliculitis is a benign complication of vaccinia vaccination, it can lead to diagnostic confusion with more severe complications such as generalized vaccinia.
Division of Infectious Diseases, Massachusetts General Hospital, Boston and Division of Immunology, New England Primate Research Center, Harvard Medical School, One Pine Hill Drive, Southborough, MA.
S.W. is supported by a career development grant from the New England Regional Center of Excellence for Biodefense and Emerging Infectious Diseases (AI057159-03). P.J. is supported by National Institutes of Health grant RR 00168 and AI62412.
Address correspondence and reprint requests to R. Paul Johnson, MD, Infectious Disease Unit, Massachusetts General Hospital, 149 13th Street, 5th Floor, Charlestown, MA 02129. E-mail: firstname.lastname@example.org.