An elderly man from Alaska has become the first person to die after contracting Alaskapox - a recently discovered viral disease.
The man from Kenai Peninsula, to the south of the state, was undergoing treatment in hospital when he died in late January, officials confirmed.
He had a history of a drug-induced weakened immune system which likely contributed to the severity of his illness, the Alaskan health department reported.
The victim was one of only seven reported Alaskapox infections, with the first identified in 2015 in an adult who suffered from a localised rash and swollen lymph nodes.
All previous patients, also from the Fairbanks region, who had been diagnosed with the virus did not require treatment and suffered mild infections.
Alaskapox, or AKPV, is a double-stranded DNA virus with officials saying it appears to be zoonotic, primarily circulating across Alaska's state mammals with occasional transmission to humans.
Symptoms have included one or more skin lesions, swollen lymph nodes and muscle pain.
Officials said the source of the man's exposure to the virus was "unclear" - although he had reported caring for a stray cat at his home which had scratched him, possibly causing the transmission.
The man spotted a red bump in his armpit in September and was given antibiotics, however his symptoms worsened as he experienced fatigue and increased pain in the area and shoulder.
After his right arm's range of motion was impacted, the man was transferred to a hospital in Anchorage where he reported further symptoms including pox-like lesions, the case report said.
An "extensive battery" of tests were performed and showed a positive result for cowpox.
While his condition improved one week into the therapy, he would soon suffer from delayed wound healing, respiratory and kidney failure, resulting in his death.
The man began to improve about a week after treatment with intravenous medications but died in late January after experiencing kidney failure and other systemic declines, according to the bulletin.
The report said the APKV merited "increased statewide awareness" among medics due to its seemingly widespread transmission in small mammals.
It presented nine recommendations to those with suspected Alaskapox including avoiding touching lesions, keeping them dry and covered, and following hand hygiene practices.