BCG-Associated Osteomyelitis: A Case Report.
BCG (Mycobacterium bovis BCG) is a vaccine for preventing childhood tuberculosis (TB). The World Health Organization registered freeze-dried Tokyo-172 seed lot as an international reference vaccine strain in 1965, and ever since, the Tokyo-172 BCG has been used, not only in Japan, but also all over the world. However, there are some severe adverse reactions that developed beyond vaccination site and regional ipsilateral axillary lymph-nodes. Osteomyelitis is a very rare but serious late complication of BCG-immunization and results from generalized dissemination of BCG. We present a case of a 23-month-old boy with a mass lesion in the right shoulder.
He had no history of any diseases. On physical examination, the mass lesion was soft and slightly
moved by touch. He could freely move his shoulder without pain or discomfort by it. From these results, a chronic infectious disease due to weakened immune systems was suspected. On X-ray, questionable rounded radiolucent area with clear osteosclerotic margin was visualized in the proximal metaphysis to diaphysis of the right humerus (Figure 1). The right shoulder CT showed low density mass lesion in the subcutaneous fat tissue (Figure 2).
Several authors reported that some children have primary immunodeficiency diseases and there are a number of primary immune deficiency diseases prone to BCG complications.4,5 Hoshina et al5 reported that patients who had multiple osteomyelitis diagnosed with interferon-γ receptor
1 deficiency from their genetic analysis. Development of osteomyelitis of patients with no gene abnormality was 10 months (1-46 months). It was late as compared to the patients with gene abnormalities (9.5 months) (7-15 months).
Pediatr Neonatal Nurs Open J. 2016; 3(1): 1-3. doi: 10.17140/PNNOJ-3-117
