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BCGiosis as a presenting feature of a child with chronic granulomatous disease

Zahra Movahedi1, Sayna Norouzi, Setareh Mamishi

  • 1Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.

The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases
|March 18, 2011
PubMed

Insights

Bacillus Calmette Guerin (BCG) vaccination can cause severe BCGitis or BCGosis in children with primary immunodeficiencies. Chronic granulomatous disease should be considered in BCGosis diagnosis, even without other immunodeficiency signs.

Area of Science:

  • Immunology
  • Vaccinology
  • Pediatrics

Background:

  • The Bacillus Calmette Guerin (BCG) vaccine is widely administered to newborns globally.
  • BCG vaccination can lead to severe local (BCGitis) or disseminated (BCGosis) complications in immunocompromised individuals.
  • Primary immunodeficiency diseases represent a group of disorders increasing susceptibility to BCG complications.

Observation:

  • A 3.5-year-old girl presented with prolonged BCGitis that progressed to disseminated BCGosis.
  • The patient exhibited no other specific signs of immunodeficiency.
  • Immunological testing, including the nitro-blue tetrazolium test, confirmed chronic granulomatous disease.

Findings:

  • The case highlights a rare presentation of disseminated BCG disease in a child with undiagnosed chronic granulomatous disease.
  • Chronic granulomatous disease (CGD) was identified as the underlying primary immunodeficiency.
  • The nitro-blue tetrazolium test proved crucial in diagnosing CGD.

Implications:

  • Chronic granulomatous disease should be included in the differential diagnosis for all pediatric cases of BCGosis.
  • Early diagnosis of CGD is critical for managing BCG complications and preventing further morbidity.
  • This case underscores the importance of considering primary immunodeficiencies in children with severe BCG vaccine-related infections, even with atypical presentations.

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