Progressive vaccinia complicating lymphosarcoma

Necropsy findings in a case of progressive vaccinia

“…In other instances purulent inflammation was also seen (Bigler and Slotkowski, 1951;Lewis and Johnson, 1957;Somers, 1957) but the presence of bacteria in the lesions in two of these cases suggests that this was due to secondary infection. Proliferative changes of the bronchial or bronchiolar epithelium have also been noted previously (Bigler and Slotkowski, 1951;Lewis and Johnson, 1957;Flewett and Ker, 1963;Dixon, 1970). This change, although not specific, may be useful in the histological diagnosis of the lesions.…”

“…The association of progressive vaccinia with various leukaemias and lymphomas is well documented (Dixon, 1970). It is noticeable that our patient was vaccinated on two different occasions after a diagnosis of chronic lymphocytic leukaemia had been made, and that at the time of the second vaccination she was receiving large doses of two powerful immunosuppressants.…”

“…It has been said that the inclusion bodies of vaccinia are basophilic and irregular in outline (B type) and that round eosinophilic inclusions (A type) are rare, occurring only if the strain is from cowpox rather than from variola (Dixon, 1970). However, A type inclusions were present in this case and are also mentioned in seven of 17 cases of human progressive vaccinia in which histological 3* descriptions of the lesions are available (Table).…”

“…A focal necrotizing pneumonitis with little inflammation has been previously noted (Hall, Cunliffe, (1953) Not seen Keidan et al (1953) Skin Cytoplasm Eosinophilic Kozinn et al (1955) Bronchi and kidney Cytoplasm Eosinophilic Barbero et al (1955) Periostium Cytoplasm Eosinophilic Somers (1957) Skin, tongue, and 'Intracellular' Eosinophilic oesophagus S6dallian et al (1957) Skin Not stated Not stated Lewis and Johnson (1957) Skin Cytoplasm Eosinophilic Galloway and MacBean (1958) Not seen Medansky et al (1960) Not mentioned Kozlowska and Sztymela (1962) Not mentioned Flewett and Ker (1963) Skin Cytoplasm and nuclei Eosinophilic White (1963) Not mentioned O'Connell et al (1964) Skin Cytoplasm Eosinophilic Van Rooyen et al (1967) Not seen Dixon (1970) Not seen Kozinn, Sigel, and Gorrie, 1955;Flewett and Ker, 1963;Dixon, 1970). In other instances purulent inflammation was also seen (Bigler and Slotkowski, 1951;Lewis and Johnson, 1957;Somers, 1957) but the presence of bacteria in the lesions in two of these cases suggests that this was due to secondary infection.…”

“…In some cases visceral lesions have been found at necropsy. In children the commonest underlying cause of this complication is congenital hypogammaglobulinaemia (Kempe, 1960) and in adults the immunological deficiency often associated with leukaemias or lymphomas (Dixon, 1970).…”