| Sumario: | Abstract\nKEY POINTSWe present the case of a 20-year-old man with a non-necrotic, shallow, well-circumscribed ulcer on the shoulder. The patient had no significant medical history, although he noted that he was joining the military and received a smallpox vaccine injection at the same site several weeks earlier. While the differential diagnosis also included pyoderma gangrenosum, brown recluse bite, and Buruli ulcer, the patient’s presentation is characteristic of a typical postvaccination progression, which is self-limited. It is important for dermatologists for be aware of this postvaccination response to avoid misdiagnosis and unnecessary workup, given that the smallpox vaccine is still administered in healthcare workers and military recruits.A typical smallpox postvaccination response may appear as a papule at the inoculation site (days 3–4), progressing to a vesicle with surrounding erythema and ulceration (days 5–6). Scabs may form by days 7 to 8.Isolated ulceration at a prior inoculation site should prompt consideration of smallpox vaccination response, particularly in military or healthcare personnel, as this history alone may establish the diagnosis.Systemic symptoms, nonhealing ulcers, and generalized cutaneous involvement are key features that distinguish rare vaccine-related complications from the expected localized reaction.Prompt recognition of characteristic postvaccination progression can reduce misdiagnosis and unnecessary workup.
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