Progressive Vaccinia with Normal Antibodies

Abstract

An elderly female developed progressive vaccinia with metastatic lesions following vaccination. Normal levels of gamma globulin were present and both hemagglutinin-inhibiting and neutralizing antibodies developed in high titer. No underlying disease could be found, and a test of the ability of the patient''s leukocytes to produce inferferon failed to show a lack of such ability. The patient failed to develop the expected positive delayed skin response to vaccinia antigen, adenopathy did not occur, and a paucity of monocytes were seen in the histologic sections of a lesion. Following failure of exogenous hyperimmune gamma-globulin to effect a response, therapy with immune leukocytes was tried on two occasions. This succeeded in transferring a delayed skin response to vaccinia and on both occasions resulted in marked amelioration of the lesions. The authors postulate that the occurrence of progressive vaccinia in this case resulted from a failure of "cellular", or delayed-type, immunity to develop despite a normal response of the circulating antibodies.