Progressive vaccinia complicating lymphosarcoma

The performance of post-mortem examinations is an important part of the work of a practising pathologist.Many of these examinations would appear "straightforward" to the casual observer, but there are few in which a thorough dissection does not reveal some unexpected finding.Occasionally one is confronted by a rarity, and the post-mortem examination takes on greater significance contributing new facts to our understanding of disease processes.This report describes such a case, an example of progressive vaccinia complicating lymphosarcoma; one which stimulated a detailed histological and electron-microscopy study.Rarity alone, however, is insufficient justification for such a lengthy analysis.The most interesting aspect of this case is the gross immunological "breakdown" whereby the patient succumbed to a fulminant, disseminated infection by vaccinia virus, a virus which the vast majority of subjects localize to the skin and rapidly eliminate.That this breakdown occurred in a patient with lymphosarcoma, and was exaggerated by steroid therapy, has important implications regarding host defences to virus infection.It is these implications that make the case worthy of detailed consideration.