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Vaccinia-induced erythema multiforme - Smallpox Vaccination
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Vaccinia-induced erythema multiforme - Smallpox Vaccination

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Contributors: Art Papier MD, Vince Fulginiti MD
Other Resources UpToDate PubMed

Synopsis

Vaccinia induced erythema multiforme is the most common adverse reaction to vaccinia (smallpox vaccination). It presents with self-limited skin rashes, almost all of which are benign, 1 to 2 weeks after vaccination. Studies conducted in 2003 and 2007 indicate that 6 to 14 percent of adult vaccinees develop rashes at sites other than the vaccination. These rashes may occasionally be frightening in appearance.

Previously these rashes were all grouped under the diagnostic concept of erythema multiforme. It is unlikely that all of these rashes are true erythema multiforme. Like erythema multiforme minor, they are either transient toxic or allergic reactions and require only symptomatic therapy or, rarely, they are a more serious eruption such as Stevens-Johnson Syndrome, which often requires hospitalization due to the severe mucosal involvement and other systemic complications.

There are no known methods to predict or prevent these reactions, although some believe that allergic persons may be more likely to develop them. Immunologic data on affected vaccinees is lacking. Some investigators believe that a concurrent enterovirus infection causes the rash but data are insufficient to determine if this is a true association.

Codes

ICD10CM:
T88.1XXA – Other complications following immunization, not elsewhere classified, initial encounter

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Differential Diagnosis & Pitfalls

The vesicular and papular eruptions may be diagnostically problematic, depending on the extent and evolution of the individual lesions, as they may be mistaken for generalized vaccinia or accidental implantation. The lesions of generalized vaccinia and accidental implantation tend to occur later, are devoid of massive erythematous reactions, and evolve in a manner similar to primary vaccinations.

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Last Updated: 07/09/2013
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Vaccinia-induced erythema multiforme - Smallpox Vaccination
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Vaccinia-induced erythema multiforme : Erythema, Individual recently immunized with vaccinia, Scattered many, Widespread, Pruritus, Smooth plaques
Clinical image of Vaccinia-induced erythema multiforme
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