Abstract
Progressive vaccinia (PV) is a rare but potentially lethal complication that develops in smallpox vaccine recipients with severely impaired cellular immunity. We describe a patient with PV who required treatment with vaccinia immune globulin and who received 2 investigational agents, ST-246 and CMX001. We describe the various molecular, pharmacokinetic, and immunologic studies that provided guidance to escalate and then successfully discontinue therapy. Despite development of resistance to ST-246 during treatment, the patient had resolution of PV. This case demonstrates the need for continued development of novel anti-orthopoxvirus pharmaceuticals and the importance of both intensive and timely clinical and laboratory support in management of PV.
Publication types
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Research Support, N.I.H., Intramural
MeSH terms
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Adult
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Antibodies, Viral / administration & dosage*
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Antiviral Agents / administration & dosage*
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Antiviral Agents / pharmacology
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Benzamides / administration & dosage*
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Cytosine / administration & dosage
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Cytosine / analogs & derivatives*
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Drug Resistance, Viral
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Humans
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Immunoglobulins / administration & dosage
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Isoindoles / administration & dosage*
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Male
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Organophosphonates / administration & dosage*
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Smallpox Vaccine / administration & dosage
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Smallpox Vaccine / adverse effects
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Treatment Outcome
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Vaccinia / diagnosis*
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Vaccinia / drug therapy*
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Vaccinia virus / isolation & purification*
Substances
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Antibodies, Viral
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Antiviral Agents
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Benzamides
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Immunoglobulins
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Isoindoles
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Organophosphonates
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Smallpox Vaccine
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brincidofovir
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Cytosine
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tecovirimat