Abstract
Background
A 17-year-old boy on long-term immunosuppression following renal transplantation for chronic kidney disease (CKD), the result of dysplastic kidneys, initially presented with a swelling in his neck while attending hospital for an unrelated problem. A clinical diagnosis of tonsillitis was made, and he was treated with broad-spectrum antibiotics. Over a few days, his condition deteriorated, and he developed multiple vesicopustular skin lesions and required an emergency tonsillectomy due to respiratory distress.
Case diagnosis/treatment
Histological investigation of the skin and tonsillar tissue suggested a viral aetiology, and subsequent electron microscopy and polymerase chain reaction (PCR) tissue examination proved disseminated cowpox infection. The family cat, which was reported as having self-resolving sores on its skin, was likely the source of the infection. The child failed to respond to antiviral treatment and succumbed to multiorgan failure within a month of admission.
Conclusions
We report this case of fatal disseminated cowpox infection to highlight an increasing risk of this illness in the post-transplant population and to detail some unusual features not previously described, such as tonsillar involvement, disseminated skin lesions and multiorgan failure.
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References
Elsendoorn A, Agius G, Le Moal G, Aajaji F, Favier AL, Wierzbicka-Hainault E, Béraud G, Flusin O, Crance JM, Roblot F (2011) Severe ear chondritis due to cowpox virus transmitted by a pet rat. J Infect 63(5):391–393
Mancaux J, Vervel C, Bachour N, Domart Y, Emond JP (2011) Necrotic skin lesions caused by pet rats in two teenagers. Arch Pediatr 18(2):160–164
Shchelkunov SN (2013) An increasing danger of zoonotic orthopoxvirus infections. PloS Pathlog 9:e1003756
Vorou RM, Papavassiliou VG, Pierroutsakos IN (2008) Cowpox virus infection: an emerging health threat. Curr Opin Infect Dis 21(2):153–156
Pelkonen PM, Tarvainen K, Hynninen A, Kallio ER, Henttonen K, Palva A, Vaheri A, Vapalahti O (2003) Cowpox with severe generalized eruption, Finland. Emerg Infect Dis 9(11):1458–1461
Czerny CP, Eis-Hübinger AM, Mayr A, Schneweis KE, Pfeiff B (1991) Animal poxviruses transmitted from cat to man: current event with lethal end. J Vet Med B 38(6):421–431
Duraffour S, Mertens B, Meyer H, van den Oord JJ, Mitera T, Matthys P, Snoeck R, Andrei G (2013) Emergence of cowpox: study of the virulence of clinical strains and evaluation of antivirals. PLoS One 8(2):e55808
Smee DF, Gowen BB, Wandersee MK, Wong MH, Skirpstunas RT, Baldwin TJ, Hoopes JD, Sidwell RW (2008) Differential pathogenesis of cowpox virus intranasal infections in mice induced by low and high inoculum volumes and effects of cidofovir treatment. Int J Antimicrob Agents 31(4):352–359
Acknowledgments
Thank you to Matthew Hannah at the Viral Reference department, Colindale, for providing the EM image.
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Gazzani, P., Gach, J.E., Colmenero, I. et al. Fatal disseminated cowpox virus infection in an adolescent renal transplant recipient. Pediatr Nephrol 32, 533–536 (2017). https://doi.org/10.1007/s00467-016-3534-y
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DOI: https://doi.org/10.1007/s00467-016-3534-y