Fatal disseminated cowpox virus infection in an adolescent renal transplant recipient
- 356 Downloads
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.
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.
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.
KeywordsCow pox Immunosuppression Transplant Paediatric Fatal/death
Thank you to Matthew Hannah at the Viral Reference department, Colindale, for providing the EM image.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest
- 8.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):352–359CrossRefPubMedPubMedCentralGoogle Scholar