case_images: PMC3000149_01
case_images: Progression of the local reaction on the left hand after accidental
  needlestick inoculation with vaccinia virus: thumb (A, day 4; B, day 11; C,
  day 12; D, day 20; fourth and fifth fingers (E, day 7, F, day 11; G, day 12;
  H, day 20). Lesions were surgically excised to remove necrotic tissue on day
  11. Arrows indicate the lesion areas.
case_images: 02-0732-F1.jpg
case_images: PMC3000149_01_02-0732-F1.jpg
case_images: F1
case_images: A 26-year-old healthy laboratory worker, previously vaccinated against smallpox in childhood, sought treatment in March 2002 with a history of pain followed by the appearance of erythema and a pustule on the left thumb (Figure 1A). Local symptoms worsened, and on the days 5 and 6, respectively, she noticed new pustules on the fourth and fifth fingers of the same hand (Figure 1E). On day 9 after inoculation, the local lesions worsened and amoxicillin/clavunate (1,750/250 mg per day) was administered because of a clinical suspicion of secondary bacterial infection (Figure 1B, F). The hand lesions were surgically excised to remove the necrotic tissue, and pustular fluid was collected for analysis (Figure 1C, G). After the surgical procedure, the patient improved slowly until she made a full recovery (Figure 1D, H), and the lesions healed in approximately 3 weeks.