Bacille Calmette-Guérin Vaccine-Induced Tuberculous Hip Osteomyelitis in an Infant: Case report

Abstract

To this day, tuberculosis (TB) continues to pose a significant global health burden. The World Health Organization's Expanded Programme on Immunization (EPI) recommends the bacille Calmette-Guérin (BCG) vaccine for infants to protect against the haematogenous spread of primary TB and other more severe types of TB infection. We report an eight-month-old boy who presented to the Armed Forces Hospital, Muscat, Oman, in 2015 with a one-month history of intermittent fever associated with a limited range of motion in the right hip area. He was up-to-date with his EPI vaccinations and had no history of exposure to individuals with TB infections. He was initially treated for bacterial septic arthritis; however, a GeneXpert TB assay revealed the presence of Mycobacterium tuberculosis, BCG strain. To the best of the authors' knowledge, this is the first documented case from Oman of a child with TB hip osteomyelitis due to a BCG vaccination.

Bacillus Calmette-Guérin vaccine-related complications in children in Oman

“…In contrast to these findings, other studies have shown that extremity bones, mainly the lower limbs, are more commonly involved with BCG osteomyelitis than the axial skeleton. 2 , 14 …”

“… 19 Patients reporting with isolated BCG osteomyelitis had an apparently normal immunological evaluation. 2 , 14 Multiple case reports have described disseminated BCG infection in children with different types of SCID including IL7R gene mutation and JAK3 deficiency. 11 , 12 , 18 Preparation SCID patients with disseminated BCG infection for transplant was a real challenge in one of our patients.…”

“…1 In Oman, BCG vaccination was initiated in 1981. 2 In endemic countries, all newborns, except those born to mothers with HIV or with a family history of primary immune deficiency (PID), receive the vaccine in the first day of life or a few months after birth.…”

Vaccine-induced tuberculous osteomyelitis

“…Five criteria were proposed to establish the osteitis diagnosis after BCG vaccination: BCG vaccination in the neonatal period; a period of less than 4 years between vaccination and symptom onset; no contact between the child and any adults with TB; a consistent clinical profile; and TB suggestive histopathology [4,5]. Symptoms usually occur during a period ranging from a few months to 5 years post-vaccination [6]. The symptoms are non-specific, and the diagnosis is usually delayed.…”

BCG Vaccine Induced Tuberculous Osteomyelitis of Left Distal Femur in a Young Child: Case Report and Literature Review

“…Tuberculosis (TB) is an essential problem for healthcare systems especially in developing countries. TB continues to pose a significant global health burden [1]. Bacillus Calmette-Guérin (BCG) is an important vaccine used to prevent Tuberculosis (TB), especially meningeal TB and disseminated TB disease in children [2].…”