Ulceration of a previously healed BCG scar in suspected disseminated BCG infection

A 2.5-year-old boy with disseminated tuberculosis, highly suspected to be disseminated BCG infection which occurred against a background of secondary immunodeficiency due to measles and malnutrition, is presented. The initial diagnosis was post-measles bronchopneumonia, meningitis and marasmus. The final diagnosis was arrived at only because of a high clinical index of suspicion of tuberculosis which is needed in all communities with a high prevalence of tuberculosis. The absence of AIDS and the extreme rarity of ulceration of a previously healed BCG scar are noted.