Exact diagnosis can be difficult and this disorder must be differentiated from:
| • |
Erythema multiforme
|
| | (vesicular or vesiculo-papular) |
| |
Lesions of these diseases are not umbilicated and do not resemble mature vaccinations. |
| • | Eczema vaccinatum | | |
Usually differentiation is not difficult because of the patient’s history but can be difficult if the eczema is healed and history is not elicited.
However, the distribution of the lesions in the usual sites of atopic dermatitis (eczema) is helpful.
|
| • | Progressive vaccinia (early stages)
| |
| |
The primary lesion in progressive vaccinia presents without inflammation and has a characteristic appearance. |
| • | Severe chickenpox | | |
Chickenpox lesions are superficial vesicles and do not resemble vaccination lesions.
|
If smallpox is endemic, differentiation between smallpox and generalized vaccinia may be very difficult. Vaccinia lesions will occur after vaccination, but if the patient has been exposed to smallpox, he/she may have modified smallpox. Virologic differentiation is mandatory in this instance. Notify and consult your state and local health departments.
Virologic diagnosis is seldom needed. On occasion, isolation of vaccinia virus will be helpful in differentiating generalized vaccinia from some of the other disorders that may be confused with it.
For further information on laboratory testing, please visit the Laboratory Testing page.
Consultation with an immunologist is strongly recommended in order that appropriate studies, particularly of the B-cell immune system, are undertaken to determine whether an immunologic deficiency is present. This will be of importance to the patient as well as to expanding our knowledge of the cause of this particular complication.
|
