The
mechanisms underlying apparent viremic spread from a
primary vaccination site to other parts of the body
are not known. Virus is present in the blood, but clinically
only the skin appears to be a target for implantation.
Subtle minor immunologic abnormalities, particularly
of the immunoglobulin B-cell system, are suspected to
be present but such studies were not available at the
time this complication was observed.
The fact that recurrent episodes are seen in some individuals
lends credence to an immunologic defect. Antibody deficiency
is likely because the lesions result from viremia, which
is normally controlled by antibodies. Also, each of
the lesions, as well as the primary, heals without incident
and in normal fashion, suggesting that cell-mediated
immunity is intact.
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