Bacillus Calmette-Guérin-related cold thigh abscess as an unusual cause of thigh swelling in infants following BCG vaccine administration: a case series

Abstract

IntroductionThigh swelling in an infant can be a symptom of a simple benign condition or a life-threatening condition. We observed a cluster of thigh swelling episodes in infants in which the cause was Bacillus Calmette-Guérin-related cold thigh abscess. We report this unusual case series to raise awareness about this diagnosis.Case presentationsWe performed a retrospective review of five infants (four boys and one girl) who presented with Bacillus Calmette-Guérin-related left thigh abscess. The swelling was noticed by the parents at a mean period of three months prior to presentation. The ages at presentation were five, five, eight and nine months for the boys, and six months for the girl. All of the patients were healthy Saudi infants, and received the Bacillus Calmette-Guérin vaccine at birth. Clinically, all of the patients were well and did not demonstrate signs of systemic infection. All patients underwent needle aspiration, with subsequent incision and drainage in four of the five cases. The cultures obtained from the abscess fluids were the key to establishing the diagnosis. Only three patients (60%) received antituberculosis drugs. Wound healing lasted for a mean period of approximately seven months. Two-year follow-up was unremarkable for all of our patients.ConclusionsTechnical errors continue to be significant in the development of vaccine-related complications. Bacillus Calmette-Guérin-related cold thigh abscess is an extremely rare entity.

Unusual cause of thigh abscess in infant following hepatitis B vaccine administration

“…Side effects caused by vaccine injection are more commonly seen when it is administered especially in the areas with low sociocultural level and without adequate logistic support by health personnel with insufficient training. Vaccine injection to wrong side for age, inaccurate doses, use of inaccurate dilution liquids and administration of non-sterile injectors may lead to soft tissue infection (Namshan et al, 2011). Technical factors are the most important causes in post vaccine complication development (Namshan et al, 2011).…”

“…Vaccine injection to wrong side for age, inaccurate doses, use of inaccurate dilution liquids and administration of non-sterile injectors may lead to soft tissue infection (Namshan et al, 2011). Technical factors are the most important causes in post vaccine complication development (Namshan et al, 2011). For achieving optimal effect of vaccination and prevention from unnecessary local and systemic effects, vaccine should be administered via suggested route.…”

“…Although complications are expected such as pain in administration area or mild fever following hepatitis B (3%-9%), severe side effects are very rare (Sahin et al, 2011). For development of side effects following vaccine administration, administration age, quality of vaccine, administration area and technique are very important (Namshan et al, 2011). The factors associated to administration technique are the most important causes in development of post vaccine complications (Namshan et al, 2011).…”

Evento adverso pós-vacinação e erro de imunização: da perspectiva epidemiológica à percepção dos profissionais da saúde

“…), não foram encontradas evidências de que todos os tipos de EAPV abordados nesta pesquisa, com exceção do abscesso subcutâneo quente, foram causados, exclusivamente, por EI, apesar de serem referidos como uma das prováveis causas (Brasil 2014a;Al Namshan et al, 2011).…”

“…A maior TI deste tipo de abscesso foi registrado com a vacina BCG, 7,9/100.000 d.a., no Paraná, cuja técnica de administração exige conhecimento e habilidade do vacinador, pois o produto deve ser instilado em pouquíssima profundidade, com um ângulo de entrada de 10 a 15 graus (Timby, 2014). A aplicação profunda (via subcutânea), dose excessiva e contaminação durante a vacinação estão entre as causas de abscessos, úlcera >1 cm e linfadenopatias regionais (Al Namshan et al, 2011;Barreto, Pereira, Ferreira, 2006;Brasil, 2011;D'Aleo et al, 2015;Milstien, Gibson, 1990).…”