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BCG vaccination as a cause of osteomyelitis and subcutaneous abscess
Insights
BCG vaccination can lead to osteomyelitis and abscesses in young children, particularly affecting the femur. Treatment requires prolonged medication and surgery, with potential long-term complications.
Area of Science:
- Pediatrics
- Infectious Diseases
- Orthopedic Surgery
Background:
- Bacillus Calmette-Guérin (BCG) vaccination is a common method for preventing tuberculosis.
- Adverse effects of BCG vaccination can occur, including localized infections.
Purpose of the Study:
- To describe complications of BCG vaccination in young children.
- To analyze the clinical presentation, treatment, and outcomes of osteomyelitis and subcutaneous abscesses following BCG vaccination.
Main Methods:
- Case series describing ten patients with osteomyelitis and three with subcutaneous abscesses.
- Review of clinical symptoms, radiographic findings, treatment regimens, and long-term follow-up.
Main Results:
- Patients presented with pain, limping, or subcutaneous induration, typically under three years old.
- Osteomyelitis commonly affected the femur metaphysis/epiphysis; abscesses were thoracic.
- Treatment involved prolonged tuberculostatic medication and surgery, with complications including arthritis and secondary abscesses. Femoral overgrowth was noted in some cases.
Conclusions:
- BCG vaccination complications, such as osteomyelitis and abscesses, require extensive treatment with potential sequelae.
- The benefits of BCG vaccination should be carefully weighed against the risks, particularly in low tuberculosis incidence regions.
Abstract:
Ten patients with osteomyelitis and three with a subcutaneous abscess, all caused by BCG vaccination, are described. All patients were less than 3 years old and had as newborns been vaccinated intracutaneously in the left gluteal or hip area. Pain, limping, or a slightly tender subcutaneous induration were the primary symptoms. The sites of predilection of osteomyelitis were the metaphysis or epiphysis of the femur, these being affected in five out of 10 cases. All three subcutaneous abscesses were in the thoracic region. Prolonged (up to 30 months) combined tuberculostatic medication, in addition to appropriate surgical procedures, resulted in healing, but two cases of arthritis and two of secondary abscesses developed. In addition, sequestrectomy and two late operations, for coxa valga and hip subluxation, were deemed to be necessary. Radiographs showed femoral overgrowth of up to 1 cm in two symptomless patients three to seven years after the first discharge. We conclude that the benefits of BCG vaccination should be weighed against the risk of complications, especially in countries with a low incidence of tuberculosis.