Pediatric Nephrology

, Volume 32, Issue 3, pp 533–536 | Cite as

Fatal disseminated cowpox virus infection in an adolescent renal transplant recipient

  • Paul GazzaniEmail author
  • Joanna E Gach
  • Isabel Colmenero
  • Jeff Martin
  • Hugh Morton
  • Kevin Brown
  • David V Milford
Brief Report



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.


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.


Cow 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


  1. 1.
    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):391–393CrossRefPubMedGoogle Scholar
  2. 2.
    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):160–164CrossRefPubMedGoogle Scholar
  3. 3.
    Shchelkunov SN (2013) An increasing danger of zoonotic orthopoxvirus infections. PloS Pathlog 9:e1003756CrossRefGoogle Scholar
  4. 4.
    Vorou RM, Papavassiliou VG, Pierroutsakos IN (2008) Cowpox virus infection: an emerging health threat. Curr Opin Infect Dis 21(2):153–156CrossRefPubMedGoogle Scholar
  5. 5.
    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):1458–1461CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    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):421–431CrossRefGoogle Scholar
  7. 7.
    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):e55808CrossRefPubMedPubMedCentralGoogle Scholar
  8. 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

Copyright information

© IPNA 2016

Authors and Affiliations

  • Paul Gazzani
    • 1
    Email author
  • Joanna E Gach
    • 1
  • Isabel Colmenero
    • 2
  • Jeff Martin
    • 3
  • Hugh Morton
    • 4
  • Kevin Brown
    • 5
  • David V Milford
    • 6
  1. 1.Dermatology DepartmentBirmingham Children’s HospitalBirminghamUK
  2. 2.Histopathology DepartmentBirmingham Children’s HospitalBirminghamUK
  3. 3.Intensive Care DepartmentBirmingham Children’s HospitalBirminghamUK
  4. 4.Microbiology DepartmentWorcestershire Royal HospitalWorcesterUK
  5. 5.Virus Reference DepartmentPublic Health EnglandLondonUK
  6. 6.Nephrology DepartmentBirmingham Children’s HospitalBirminghamUK

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