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March 1984

Picture of the Month

Author Affiliations

Contributed from the Department of Pediatrics, Arizona Health Sciences Center, Tucson.

Am J Dis Child. 1984;138(3):321-322. doi:10.1001/archpedi.1984.02140410099027

Denouement and Discussion 

Progressive Vaccinia in an Infant With Severe Combined Immunodeficiency  C. Henry Kempe was the first to alert the medical public to the lethal complication of progressive vaccinia (vaccinia necrosum and vaccinia gangrenosum). This disorder occurred because the host could not mount an effective immunologic response to vaccinia virus. A locally progressive infection ensued, with invasion of the lymphatic channels and bloodstream, resulting in both regional extension and dissemination. The child depicted here was one of the earliest instances in the Colorado series. Dr Kempe correctly surmised that the small lymphocyte (now known as the T cell) was deficient, and the deficiency was related to abnormal development of the thymus.This child was unnecessarily vaccinated, and such instances led Dr Kempe to champion elimination of smallpox and smallpox vaccination. This was ultimately achieved in 1977, when natural smallpox was totally eliminated, and vaccination became unnecessary.Thus, this child