BCG-itis in two antiretroviral-treated HIV-infected infants

Although vaccination with Bacille Calmette-Guérin (BCG) is considered safe, adverse regional (BCG-itis) and disseminated (BCG-osis) diseases preferentially occur in the immunocompromised host. The infection with human immunodeficiency virus (HIV) by mother-to-child transmission leads to impaired cellular immune responses, a situation that poses a great challenge regarding the universal use of BCG vaccine. World Health Organization recommends that children who are known to be HIV-infected, even if asymptomatic, should no longer be immunized with BCG. Many of the complications of BCG vaccination occur in severely immunosuppressed HIV-infected children and are related to late institution of antiretroviral and antimycobacterial therapy. We report two cases of BCG-itis in HIV-infected infants, who fulfilled clinical criteria of immune reconstitution inflammatory syndrome: axillary adenitis, one with suppuration, and both temporally associated with precocious restoration of immunity elicited by the use of antiretroviral therapy. Isoniazid (10 mg/kg/day) was offered until regression of adenopathies, and lesions were not handled.