BCG osteomyelitis. Case report and review

Area of Science:

• Pediatric infectious diseases
• Orthopedic surgery
• Vaccinology

Background:

• Bacille Calmette-Guérin (BCG) vaccination is widely used for tuberculosis prevention.
• Osteomyelitis is a serious bone infection that can occur as a rare complication of BCG vaccination.
• Late-onset BCG osteomyelitis, presenting months after vaccination, poses diagnostic and therapeutic challenges.

Observation:

• A 6-month-old boy developed BCG osteomyelitis affecting the distal femur (metaphysis and epiphysis).
• The case illustrates the potential for BCG osteomyelitis to manifest significantly later than the vaccination period.
• Review of 89 published records was conducted to analyze epidemiological, diagnostic, and therapeutic aspects.

Findings:

• BCG osteomyelitis can present as a late-onset complication of neonatal BCG vaccination.
• Diagnosis requires a high index of suspicion, especially in cases with prolonged symptoms.
• Therapeutic strategies involve prolonged antimicrobial therapy and potentially surgical intervention.

Implications:

• Increased awareness among clinicians regarding late-onset BCG osteomyelitis is crucial for timely diagnosis.
• Further research is needed to optimize diagnostic criteria and treatment protocols for BCG osteomyelitis.
• Understanding the epidemiology and management of this rare complication can improve patient outcomes.