Fatal disseminated cowpox virus infection in an adolescent renal transplant recipient

Pediatr Nephrol. 2017 Mar;32(3):533-536. doi: 10.1007/s00467-016-3534-y. Epub 2016 Oct 28.


Background: A 17-year-old boy on long-term immunosuppression following renal transplantation for chronic kidney disease (CKD), the result of dysplastic kidneys, initially presented with a swelling in his neck while attending hospital for an unrelated problem. A clinical diagnosis of tonsillitis was made, and he was treated with broad-spectrum antibiotics. Over a few days, his condition deteriorated, and he developed multiple vesicopustular skin lesions and required an emergency tonsillectomy due to respiratory distress.

Case diagnosis/treatment: Histological investigation of the skin and tonsillar tissue suggested a viral aetiology, and subsequent electron microscopy and polymerase chain reaction (PCR) tissue examination proved disseminated cowpox infection. The family cat, which was reported as having self-resolving sores on its skin, was likely the source of the infection. The child failed to respond to antiviral treatment and succumbed to multiorgan failure within a month of admission.

Conclusions: We report this case of fatal disseminated cowpox infection to highlight an increasing risk of this illness in the post-transplant population and to detail some unusual features not previously described, such as tonsillar involvement, disseminated skin lesions and multiorgan failure.

Keywords: Cow pox; Fatal/death; Immunosuppression; Paediatric; Transplant.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Cowpox / pathology
  • Cowpox / virology*
  • Cowpox virus / genetics
  • Fatal Outcome
  • Humans
  • Kidney Transplantation / adverse effects*
  • Male
  • Multiple Organ Failure / etiology
  • Polymerase Chain Reaction
  • Renal Insufficiency, Chronic / surgery
  • Skin Diseases / etiology
  • Skin Diseases / virology
  • Tonsillitis / drug therapy
  • Transplant Recipients


  • Anti-Bacterial Agents