Papular spongiotic dermatitis of smallpox vaccination: Report of 2 cases with review of the literature
Department of Pathology, Madigan Army Medical Center, Tacoma, Wash, USA.Archives of pathology & laboratory medicine (Impact Factor: 2.84). 11/2004; 128(10):1173-5. DOI: 10.1043/1543-2165(2004)128<1173:PSDOSV>2.0.CO;2
We report 2 cases of nonspecific postvaccinial dermatitis following smallpox vaccination. The patients presented with diffuse, pruritic, erythematous macules and papules 11 days (case 1) and 7 days (case 2) following routine smallpox vaccination. Biopsies of the lesions demonstrated spongiotic dermatitis without evidence of viral cytopathic changes. One case showed a pityriasis rosea-like histologic pattern. The exanthema resolved without sequelae with symptomatic treatment (case 1). Review of historical literature demonstrated the association of a variety of nonspecific cutaneous complications with vaccinia inoculation, including erythema multiforme, urticaria, and pityriasis rosea. The association of these various dermatitides with smallpox immunization is not well known and is likely underreported.
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ABSTRACT: Pityriasis rosea is an acute, self-healing exanthem characterized by oval erythematous-squamous lesions of the trunk and limbs, that usually spares face, scalp, palms, and soles. Constitutional symptoms, which have the character of true prodromes; clinical features, which resemble those of the known exanthems; and many epidemiologic data all suggest an infectious origin. A host of infectious agents have been incriminated, but, recently, human herpesvirus 6 and 7 have been extensively studied. The goal of this review is to outline the epidemiologic, clinical, histologic, and ultrastructural features of pityriasis rosea, but mainly to stress its possible human herpesvirus nature. In addition, clues have been added to help the reader to go through the complex subtleties of the virologic investigation.Journal of the American Academy of Dermatology 09/2009; 61(2):303-18. DOI:10.1016/j.jaad.2008.07.045 · 4.45 Impact Factor
Chapter: The spongiotic reaction patternWeedon's Skin Pathology, 01/2010: pages 93-122.e23; , ISBN: 9780702034855
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ABSTRACT: Author Summary The purpose of vaccination against viruses is to induce strong neutralizing antibody responses that inactivate viruses on contact and strong T cell responses that attack and kill virus-infected cells. Some viruses, however, like HIV and hepatitis C virus, are only weakly controlled by neutralizing antibody, so T cell immunity is very important for control of these infections. T cells recognize small virus-encoded peptides, called epitopes, presented on the surface of infected cells, and some of these epitopes induce strongly protective and others weakly protective T cell responses. However, the same T cells can sometimes demonstrate cross-reactivity and recognize similar epitopes encoded by two different viruses. We questioned here what infection with a virus encoding a weak cross-reactive epitope would do to immunity to a previously-encountered virus. Here we report that such an infection can compromise protective immunity by enhancing the normally weak response and suppressing the normally strong response. Under these conditions such epitopes function as “pathogenic” epitopes, and we suggest that the potential for inducing responses to pathogenic epitopes should be an important consideration in the design of T cell vaccines.PLoS Pathogens 04/2012; 8(4):e1002633. DOI:10.1371/journal.ppat.1002633 · 7.56 Impact Factor
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