Diagnostic Value of the Reaction at the Bacillus Calmette-Guérin Vaccination Site in Kawasaki Disease

Abstract

Objective: To describe the case of an infant - diagnosed with incomplete Kawasaki disease - who developed BCG scar reactivation. Case description: A 6-month-old patient was admitted to hospital with fever associated with ocular hyperemia, cervical lymphadenopathy, and hyperemic lips, and remained hospitalized for 12 days. The physical examination revealed an inflammatory reaction at the site of the BCG scar, leading to the diagnosis of incomplete Kawasaki disease. The patient was treated with venous immunoglobulin, but presented recurrence of Kawasaki disease, with subsequent onset of coronary artery disease. Comments: BCG scar reactivation is an important finding in countries where the vaccine is routinely given and may be a useful marker for early diagnosis of Kawasaki disease, especially in its incomplete form.

BCG Scar Local Skin Inflammation as a Novel Reaction Following mRNA COVID-19 Vaccines in Two International Healthcare Workers

“…Although not specific, the dermatological changes at the BCG inoculation site scar have been also described in KD, particularly in young infants, even though its mechanism is not fully understood. However, in children older than two years of age and, even more, in adolescents or adults suffering from KD, this reaction is extremely rare [1][2][3][4][5]. Other case reports have been published in association with viral infections such as measles and HHV6 [6][7].…”

“…Inflammatory reactions of the Bacillus Calmette-Guérin (BCG) scar have been mostly reported as a feature in children with Kawasaki disease (KD), particularly in the first two years of life, as it has previously been described [1][2][3][4][5]. This phenomenon is characterized by erythema, induration, ulceration, and/or crust formation at the inoculation site.…”

Enfermedad de Kawasaki: Definición, etiología, diagnóstico y manejo de la fase aguda

“…Usualmente son niños menores de 1 año, tienen mayor riesgo de ser refractarios a la IGIV y más riesgo de complicaciones cardíacas. 19,20 Enfermedad de Kawasaki atipica El término Kawasaki atípico debería reservarse para aquellos pacientes, que presentan manifestaciones asociadas que generalmente no se observan en la EK. En el curso atípico, debemos tener presentes los siguientes datos útiles para el diagnóstico de la enfermedad de Kawasaki: pacientes menores de un año o escolares y adolescentes, fiebre que dura más de 9 días, exantema en piel por largos periodos de tiempo, problema renal o hepático, dolor abdominal agudo, hidrops de vesícula biliar, hepatitis, colangitis, pancreatitis, meningitis aséptica, uveítis anterior, hipoacusia, artritis, uretritis, derrames pleurales, parálisis de nervios faciales, eritema del sitio de aplicación de BCG (vacuna contra la tuberculosis).…”