Treatment of progressive vaccinia. Use of methisazone, vaccinia immune serum globulin, and surgical debridement

Progressive vaccinia (vaccinia gangrenosum, vaccinia necrosum) is a rare complication of smallpox vaccination characterized by progressive necrosis at the vaccination site and often accompanied by metastatic necrotic vaccinial lesions elsewhere in the body. It occurs mostly in persons with altered immune responses. Previously considered invariably fatal, survival of patients with progressive vaccinia has now been reported after treatment with vaccinia immune serum globulin1,2and methisazone (Marboran).3 In this report we describe a patient with lymphosarcoma in whom revaccination for smallpox led to progressive vaccinia. The case illustrates the failure of vaccinia immune serum globulin given shortly after vaccination to prevent appearance of progressive vaccinia. Administration of therapeutic courses of vaccinia immune serum globulin and methisazone resulted in improvement but failed to eradicate the lesion. A second course of methisazone together with surgical debridement resulted in the elimination of virus from the necrotic lesion, and skin grafting led to