Post-Smallpox Vaccination Skin Eruption in a Marine

This case report examines a vesiculopustular reaction which occurred in a young Marine 9 d after receiving the smallpox vaccination. Review of the CDC guidelines, ACAM2000 package insert, and literature surrounding the smallpox vaccine reveals several well-established adverse cutaneous reactions associated with vaccination. These dermatologic reactions are typically mild and self-limited, but do have the potential to be life threatening - especially in those with immunocompromise. Unfortunately, the correct diagnosis can often be difficult to make, as many of these rashes share similar characteristics. Furthermore, the low overall incidence of some exanthema associated with the smallpox vaccination makes familiarization with these rashes difficult for the primary provider. This case report includes a review of the associated literature and seeks to offer the clinician some familiarity of the skin eruptions associated with the smallpox vaccination. Self-limited skin eruptions such as autoinoculation, nonviral pustulosis, and generalized vaccinia will be distinguished from the more serious eczema vaccinatum, and from the potentially life-threatening progressive vaccinia.