The case of a 5-year-old boy who showed progressive necrosis of the site of a primary vaccination on the left deltoid area is reported. The term vaccinia gangrenosa is suggested to distinguish such cases from other types of generalized vaccinia. By the time he was first seen at the hospital, 4 months after the vaccination, there were metastatic lesions to other areas of skin on the arm, chest, scalp and to the shaft of the fourth metacarpal of time right hand where an osteomyelitis developed. Vaccinia virus was isolated from the necrotic lesion of the skin of the arm and from the bone lesion. No circulating antibodies to vaccinia virus were found in the blood stream.Upon treatment with hypermmune vaccinal gamma globulin derived from recently vaccinated adults the lesion immediately showed healing. After a total of 5 doses, given over the course of 6 weeks, vaccinia virus was no longer detectable in the skin lesion. All primary and metastatic lesions were completely healed by 4? months after the first treatment. This boy is unusual for 2 reasons: (a) he appears to be the first patient to have survived this complication of routine smallpox vaccination, and (b) an osteomyelitis which developed was shown to be due to vaccinia virus.
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