By NewsDesk  @infectiousdiseasenews

In today’s New England Journal of Medicine Images in Medicine portion, two ophthalmologists from the Royal Free Hospital in London report on a case of orbital cowpox infection.


According to the article, a 28-year-old woman presented to the emergency department with a 5-day history of worsening redness, irritation, and discharge in the right eye.

She was given a number of antibiotics and antivirals, but despite the regimen, conjunctival necrosis, marked orbital inflammation, and ophthalmoplegia developed. Emergency procedures were performed to decompress the orbit, and necrotic tissue was debrided.

It was discovered that the patients cat had developed lesions on the paws and head two weeks prior to the patient developing symptoms.

PCR testing on the cat, ordered by the vet, revealed it was positive for orthopoxvirus.

Testing on the patient’s conjunctiva was also PCR positive for orthopoxvirus and genomic sequencing confirmed a diagnosis of cowpox.

Her treatment plan now included tecovirimat, which inhibits the orthopoxvirus VP37 envelope wrapping protein, and also received oral prednisolone, topical dexamethasone, and topical moxifloxacin.

In addition, She underwent additional surgical debridement 2 months later and received a prolonged course of tecovirimat. At follow-up 6 months after presentation, visual acuity in the patient’s right eye was 20/20, although she had a mild residual ptosis and some restriction of extraocular movements, mainly elevation and adduction of the right eye.