Unusual Presentation of Bacille Calmette-Guérin (BCG) Osteomyelitis in Immunocompetent Saudi Child: A Case Report
Abstract
Osteomyelitis is a rare complication of Bacillus Calmette-Guerin (BCG) vaccine particularly in Immunocompetent children. Recognition and Management of BCG osteomyelitis is challenging. Herein a 7-months-old Saudi girl admitted with right foot swelling, clinical diagnosis of cold abscess was made. MRI imaging revealed osteomyelitis of 1st right tarsal bone, open biopsy tissue culture and PCR were positive for mycobacterium bovis. BCG osteomyelitis is devastating complication of BCG vaccination that should be considered in the appropriate clinical setting.
Keywords
Download Options
Introduction
BCG Osteomyelitis is a rare complication of BCG vaccination in Immunocompetent hosts, This late complication may occur in children four to 24 months after vaccination. BCG osteomyelitis may occur as a result of direct spread from the vaccine administration site, or less commonly may occur as a result of dissemination of BCG infection. The lesions are usually localized in the metaphysis or epiphysis of long bones. 1,2 The incidence varies between countries, it has been reported in 0.01 per million vaccinees in Japan (multipuncture technique) and 30 per million in Finland (intradermal technique). 1,2 In Saudi Arabia, although all of the newborns are vaccinated with BCG within the first year of life, few cases only were reported with the diagnosis of culture-proven BCG osteomyelitis in immunecompetent children. 3
Herein, we report culture proven BCG osteomyelitis in immunocompetent infant that was confirmed by real-time polymerase chain reaction (PCR). The aim of this report is to discuss the unusual presentation of BCG osteomyelitis among the immunocompetent patients.
Conclusion
Because BCG Osteomyelitis is a rare complication of BCG vaccination , high index of suspicion should be considered in cases of osteomyelitis with clinical, radiological and histopathology presentation suggestive of tuberculosis and negative for usual bacterial culture. Therefore, mycobacterium culture and PCR for BCG should be considered.