BCG vaccine
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BCG vaccine Blistering lesion following accidental intramuscular administration, treated with prednisolone and antituberculars: case report A 24-year-old woman developed a blistering lesion following accidental intramuscular administration of BCG vaccine (Tokyo 172) instead of purified protein derivative (PPD). The woman was scheduled to undergo a two-step tuberculin skin test (TST). During the first TST, she developed redness without induration. After 2 weeks, the second TST was performed, after which she noticed a blistering lesion at the injection site along with severe pain in the night. The next day, it was revealed that she had accidentally received BCG vaccine [dosage not stated] in place of PPD. She then presented with a remarkably swollen and enlarged right arm. She had a blistering lesion at the injection site, which was surrounded by 200 × 120mm of redness. Laboratory investigations revealed a mildly elevated C-reactive protein level of 0.93 mg/dL. Ziehl-Nielsen staining showed acid-fast bacilli in the sample obtained from the blister. The organisms were later identified as Mycobacterium bovis. The woman started receiving oral prednisolone 40 mg/day. On day 16, isoniazid, rifampicin and ethambutol were added; prednisolone was stopped on day 7 after a significant improvement in her symptoms. However, on day 21, oral prednisolone 40 mg/day was restarted after the inflammatory changes on her arm had started to worsen. Prednisolone dosage was then gradually decreased and it was discontinued on day 63. On the day of prednisolone discontinuation, she had an ulcerous lesion without any pain. After 24 weeks, antitubercular treatment was completed, at which time her lesion had completely cleared without any scar. Watanabe K, et al. Successful treatment of ulcerous skin lesion caused by mistaken intradermal injection of BCG (Bacille de Calmette et Guerin) vaccine with antituberculous drugs and systemic administration of corticosteroid. Internal Medicine 801154900 48: 1323-1325, No. 15, 2009 - Japan
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Reactions 16 Jan 2010 No. 1284
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