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Pediatr Nephrol. 2017 Mar;32(3):533-536. doi: 10.1007/s00467-016-3534-y. Epub 2016 Oct 28.

Fatal disseminated cowpox virus infection in an adolescent renal transplant recipient.

Author information

1
Dermatology Department, Birmingham Children's Hospital, Birmingham, UK. p.gazzani@nhs.net.
2
Dermatology Department, Birmingham Children's Hospital, Birmingham, UK.
3
Histopathology Department, Birmingham Children's Hospital, Birmingham, UK.
4
Intensive Care Department, Birmingham Children's Hospital, Birmingham, UK.
5
Microbiology Department, Worcestershire Royal Hospital, Worcester, UK.
6
Virus Reference Department, Public Health England, London, UK.
7
Nephrology Department, Birmingham Children's Hospital, Birmingham, UK.

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.

KEYWORDS:

Cow pox; Fatal/death; Immunosuppression; Paediatric; Transplant

PMID:
27796621
DOI:
10.1007/s00467-016-3534-y
[Indexed for MEDLINE]

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