Hypogammaglobulinemia in a child. Large sore in the arm of a 22-month-old boy with Bruton's hypogammaglobulinemia accompanied by vaccinia necrosum. Vaccinia necrosum, or progressive vaccinia, is a rare cutaneous condition caused by the vaccinia virus, It is characterised by painless but progressive necrosis (tissue death) and ulceration. Hypogammaglobulinemia is a rare disease where the body is unable to produce immune antibodies. Photographed in the USA, in 196MB8.