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Eczema vaccinatum demands urgent treatment with Vaccinia Immune Globulin. Mortality has generally been prevented if patients are treated promptly and adequately. However, even if there is a delay in recognition, prompt institution of VIG should be undertaken.
Normally, the initial dose of intramuscular VIG (IM-VIG) is 0.6-1.0 ml per kg body weight. However, if the lesions are extensive when first seen, as much as 5-10 ml per kg of IM-VIG, divided into multiple doses, and given over several days should be administered.
The current IM-VIG is an experimental drug and is only available under the IND protocol.
Intravenous VIG (IV-VIG) may be available in the near future. Specific recommendations for its use should be followed.
With bacterial infection, appropriate antibiotic treatment should be guided by most probable organisms (staphylococcus aureus, streptococci, and enteric bacteria) and subsequently by results of culture and sensitivity. Fungal infections should be treated by the appropriate antifungal agent. It is recommended that an infectious disease specialist be consulted. For treatment of the underlying atopic dermatitis, a dermatologist should be consulted.
If septic shock supervenes then all appropriate measures should be employed based on clinical observations and laboratory data.
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