Bacille Calmette-Guérin Osteomyelitis

Area of Science:

• Pediatric Infectious Diseases
• Skeletal Infections
• Vaccine-Preventable Diseases

Background:

• Tuberculosis remains a significant global health challenge, particularly in developing nations.
• Bacillus Calmette-Guérin (BCG) vaccination is standard for newborns in Iran to prevent tuberculosis.
• Osteomyelitis secondary to BCG vaccination is a rare but serious condition, often affecting long bone epiphyses.

Purpose of the Study:

• To report on the clinical presentation, diagnosis, and management of BCG-induced osteomyelitis in children.
• To highlight the importance of considering BCG osteomyelitis in the differential diagnosis of pediatric bone infections.

Main Methods:

• A retrospective case series involving four pediatric patients (3 male, 1 female, aged 11-24 months) with BCG osteomyelitis.
• Radiological assessment revealed lytic bone lesions with cortical destruction and periosteal reaction.
• Diagnostic methods included core needle biopsy, open surgery, pathology (granulomatous osteomyelitis, caseous necrosis), and PCR studies.

Main Results:

• The affected bones included metatarsals, talus, humerus, and tibia.
• Surgical intervention involved curettage and debridement of the affected bone and surrounding tissues.
• All patients received standard anti-tuberculosis pharmacotherapy and achieved a complete cure with no short-term complications at one-year follow-up.

Conclusions:

• BCG osteomyelitis and cold abscess should be considered in children with chronic symptoms like pain, limping, or swelling.
• A significant delay between BCG vaccination and symptom onset necessitates thorough pathological evaluation.
• Prompt diagnosis via image-guided biopsy and PCR, combined with surgical debridement and chemotherapy, ensures favorable clinical outcomes.