Vaccinia Folliculitis After Primary Dryvax Vaccination

Smallpox vaccination has been associated with a number of rare, but clinically significant, complications including a wide variety of exanthems. Among these is vaccinia folliculitis, which typically coincides with the peak of viral replication at the vaccination site. Viable vaccinia virus has not been isolated from these lesions, which heal without scarring. We report a case of vaccinia folliculitis in a vaccinia-naive laboratory worker who subsequently developed swelling and violet discoloration of his hands and feet. Although vaccinia folliculitis is a benign complication of vaccinia vaccination, it can lead to diagnostic confusion with more severe complications such as generalized vaccinia.