Osteomyelitis due to BCG vaccination

CERQUEIRO, C; SQUASSI, I; GARCÍA LIZZIERO, M; TRAMA L; BEZRODNIK, L; DE MATTEO E; RIVAS, N; LÓPEZ, E

Buenos Aires- Argentina

Congreso; 6º World Congress of the World Sociey for Pediatric Infectious Diseases; 2009

BCG is one of the safest vaccines being used, and osteitis(OBCG) is a rare complication of it (1 per million vaccinations). OBCG is diagnosed between one to five years after vaccination, usually on methaphyses of long bones. The aim was evaluate clinical features, diagnostic findings and prognosis for OBCG observed over a 6-years period A retrospective analysis of 4patients with OBCG was performed. Results: On a total of 211patients with BCGcomplications, osteolytic bones lesions were detected in four. All cases were well nourishing, without neonatal pathologies or contact with TB and had been inoculated with BCG at birth. Chest x-rays were normal, except one with chronic aspiration. Routine serologies were negative; bone scans showed increase uptake at the lesions; bone biopsies revealed granulomatous osteomyelitis and the cultures developed Mycobacterium bovis (BCG). Patients started four antituberculous drugs at the result of histology, except case3 who had clear LCR meningitis and begun earlier. Case Sex Age PPD(mm) Time evolution before treatment Localization 1 F 5month 6 20 days Knee distal femur 2 F 8month 15 60 days Foot first metatarsus finger 3 F 2years 0 45 days Shoulder proximal humerus 4 M 2years 15 60 days Hip trochanter mayor femur Even first studies were normal; defect in immune response is still under examination in cases 2to4. All got cured with drug therapy without osseous sequel. Conclusions: Differential diagnosis required biopsy and the systematic culture of it allowed the BCG isolation The granulomatous histology oriented the diagnosis and early treatment The search for deep focus and immunological profile are mandatory OBCG should be suspect in a child with subacute or chronic granulomatous osteitis, with normal chest x-ray and without tuberculosis contact.