BCG vaccine/isoniazid/rifampicin
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Various toxicities: case report A 16-month-old boy developed Bacillus Calmette-Guerin (BCG) strain meningitis, ventriculitis, neurosarcoidosis, hydrocephalus and bilateral blindness following vaccination with BCG vaccine. Additionally, he also developed allergy to isoniazid and rifampicin [not all routes, dosages and outcomes stated; times to reactions onsets not stated]. The boy was diagnosed with hydrocephalus at the age of 16 months presented to hospital. He had been inoculated with BCG vaccine at 7 months of age. He had been unable to see his parents for 2 months and had developed progressive gait disturbance 2 weeks prior to admission. His father had undergone tumorectomy for an intracranial schwannoma 6 months prior. On admission, he could not stand up from a sitting position and had already lost vision in both eyes. MRI showed significant dilation of the bilateral lateral and third ventricles, enhancement of the ventricular wall, thickening of the third ventricular floor and aqueductal stenosis. One week after admission, he underwent ventricular drainage and endoscopic tissue biopsy of the pathological ventricular wall. Endoscopy revealed various military nodules in the ventricular wall and obstruction of the aqueduct. Cerebrospinal fluid (CSF) analysis showed WBC 50 mononuclear cells/mm3, total protein 254 mg/dL, glucose 31 mg/dL, chloride 115 mmol/L, adenosine deaminase (ADA) 15.3 U/L and angiotensin-converting enzyme (ACE) 1.1 U/L. HIV, hepatitis B and hepatitis C tests were negative. Biopsy specimens of brain tissue revealed non-caseous granulomatous inflammation with no evidence of malignancy or infection. Interferon-gamma release assays (IGRAs) were negative. Bacterial and mycobacterial cultures of the CSF were negative, and a PCR assay of the M. tuberculosis (MTB) complex was also negative. Chest and abdominal contrast-enhanced CT scans did not reveal any abnormal findings. Infections were ruled out, and a diagnosis of neurosarcoidosis was made. Thus, the boy underwent ventriculoperitoneal shunting for hydrocephalus on day 19 of admission. He started receiving treatment with methylprednisolone on day 26 of admission, and his CSF findings gradually improved. A brain MRI showed that the size of the ventricles had been reduced, but remained enlarged bilaterally. After treatment with prednisolone, the CSF findings again worsened. Thus, methotrexate was added on day 50 after admission. Additionally, infliximab was administered on day 74 and 96 after admission as CSF findings did not improve. During treatment for neurosarcoidosis, his CSF findings were as follows: WBCs 57–351 cells/mm3, total protein 87–489 mg/dL and glucose 15–55 mg/dL. Three months after admission, he experienced vomiting and persistent fever. Due to persistent, unexplained fever, the CSF culture was reexamined to rule out shunt-related infections. Polymerase chain reaction (PCR) showed positive results for the Mycobacterium tuberculosis (MTB) complex. Due to the possibility of complicating tuberculosis (Mycobacterium tuberculosis or
