J Korean Med Sci.  2012 Feb;27(2):221-224. 10.3346/jkms.2012.27.2.221.

Severe Osteomyelitis as a Complication of Tokyo-172 BCG Vaccination

• Kwon HJ
• Chung BH
• Choi BM
• Park KU
• Kim YK

• KMID: 1120164
• DOI: http://doi.org/10.3346/jkms.2012.27.2.221

Abstract

The bacilli Calmette-Guerin (BCG) Tokyo-172 strain was considered to exhibit good protective efficacy with a low rate of unfavorable side effects. However, we describe a rare case of BCG osteomyelitis developed in an immunocompetent host who was given with BCG Tokyo-172 vaccine on the left upper arm by multipuncture method. A 9-month-old girl presented with progressive inability to move her right elbow and had radiographic evidence of septic elbow combined with osteomyelitis of right distal humerus. A biopsy from the site revealed chronic caseating granulomatous inflammation, positive for BCG Tokyo-172 strain on the multiplex polymerase chain reaction. The child had to undergo second surgical debridements and oral antituberculosis chemotherapy. There were no sequelae after 2 yr of follow-up. This complication, although uncommon, should be considered in the appropriate clinical setting.

Keyword

Osteomyelitis; Complication; Bacilli Calmette-Guerin Vaccination

MeSH Terms

Antitubercular Agents/therapeutic use
BCG Vaccine/*adverse effects
DNA, Bacterial/genetics
Female
Humans
Infant
Magnetic Resonance Imaging
Multiplex Polymerase Chain Reaction
Mycobacterium bovis/genetics/*isolation & purification
Osteomyelitis/drug therapy/*etiology/*microbiology/surgery

Figure

• 

  Fig. 1 The detection of BCG substrain using the multiplex polymerase chain reaction. The sample of this patient shows an identical amplification with the Mycobacterium bovis BCG Tokyo-172 strain. M, marker; N, negative; MTB, M. tuberculosis; Pasteur, M. bovis BCG Pasteur; Tokyo, M. bovis BCG Tokyo-172.

• 

  Fig. 2 Magnetic resonance image showing a high signal intensity and enhancement in head of proximal radius. Synovial hypertrophy and fluid collection in elbow joint.

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