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Rash in a U.S. Marine After Predeployment Vaccinations


Am Fam Physician. 2017 Jan 1;95(1):37-38.

A 20-year-old U.S Marine presented with a rash on his left upper arm. He reported getting a mild sunburn nine days earlier. Three days after the sunburn, he received routine vaccinations before overseas deployment. The vaccines included anthrax, hepatitis A and B, Japanese encephalitis virus, typhoid, and vaccinia virus (smallpox). He first noted a small, slightly erythematous, raised rash on his left upper deltoid area two days before presentation. Within 24 hours, the rash had become several times larger. The patient reported discomfort in the area. He did not have a fever or history of similar episodes.

On physical examination, the patient was comfortable and in no acute distress. His skin examination revealed a 5- × 2-cm erythematous plaque on the left upper lateral deltoid area that continued distally with an 8- × 4-cm area of coalescing umbilicated papules (Figure 1).

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Figure 1.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Eczema vaccinatum.

B. Erythema

Address correspondence to Jason L. Ferguson, DO, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

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3. Fauci AS. Smallpox vaccination policy—the need for dialogue. N Engl J Med. 2002;346(17):1319–1320.

4. Centers for Disease Control and Prevention. Update: adverse events following civilian smallpox vaccination—United States, 2003. MMWR Morb Mortal Wkly Rep. 2004;53(5):106–107.

5. Lane JM, Ruben FL, Neff JM, Millar JD. Complications of smallpox vaccination, 1968. N Engl J Med. 1969;281(22):1201–1208.

6. Reed JL, Scott DE, Bray M. Eczema vaccinatum. Clin Infect Dis. 2012;54(6):832–840.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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