BCG vaccine
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Tuberculous osteomyelitis and subcutaneous abscess in an infant: case report A boy developed tuberculous osteomyelitis and subcutaneous abscess following vaccination with the BCG vaccine. The boy had received the BCG vaccine at 1 month of age [route and dosage not stated]. He presented at 10 months of age with a subcutaneous mass in his left lower leg. A swelling had developed in his left leg below the knee over the preceding 2 months. A BCG scar with intact skin over his left deltoid region was observed. The mass below his left knee was tender and palpable. He had a WBC count of 23 580 cells/mm3 and a CRP level of 0.3 mg/dL. X-ray demonstrated an osteolytic lesion with cortical destruction and periosteal reaction in the proximal metaphysis of his tibia. Subsequent MRI revealed a pedicle-based juxtacortical abscess with communication to the cortex and marrow space, as well as tibial marrow infiltration. The boy underwent surgical debridement and aspiration of a thick yellow material. His tibia was curetted and the mass was excised. The excised mass showed a chronic granulomatous reaction, lymphocyte infiltration, giant cells and epithelioid aggregates. The specimen was negative for acid-fast bacilli; however, subsequent PCR confirmed the final diagnosis of BCG-induced tuberculous osteomyelitis. He received isoniazid and rifampicin. Follow-up MRI at 18 months showed that the affected site had healed with residual fibrosis in the tibia. He recovered fully without complications. Author comment: "[W]e report an unusual case in which a subcutaneous abscess occurs due to BCG-related tuberculous osteomyelitis." Chang C-K, et al. Subcutaneous abscess in the lower leg caused by BCG-related osteomyelitis. Southern Medical Journal 103: 686-689, No. 7, Jul 2010. Available 803031416 from: URL: http://dx.doi.org/10.1097/smj.0b013e3181e1e42f - Taiwan
0114-9954/10/1314-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 14 Aug 2010 No. 1314
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