Development of Chancre-Variant Cutaneous Tuberculosis After BCG Vaccine Administration in a Patient With Migraines

Abstract

In countries other than the United States, the BCG vaccine is typically used as a method for preventing childhood tuberculosis; in the United States, the BCG vaccine has gained popularity as a speculated therapy for autoimmune and inflammatory disorders. Research suggests that the vaccine can train the innate immune response, thereby improving symptoms of disorders such as diabetes and fibromyalgia. However, the potential side effects associated with the use of this vaccine are not totally innocuous. Although 95% of recipients should expect common skin complications after administration of the BCG vaccine, other more serious cutaneous sequelae may occur. Potential cutaneous side effects associated with vaccine use can include fistulation, abscess formation, and even ulceration. This brief report highlights a patient in whom cutaneous tuberculosis developed, specifically tuberculous chancre, secondary to receiving the BCG vaccine as a possible treatment for fibromyalgia. After undergoing surgical debulking of the tumor, the patient subsequently received the standard of care to the wound base and was started on 6 months of isoniazid monotherapy. Cutaneous tuberculosis is exceedingly rare, and the chancre variant accounts for only about 1% of diagnosed cases. Although common in pediatric populations, the chancre variant of cutaneous tuberculosis is not typically seen in adult populations, most likely because the BCG vaccine is often administered to children to prevent childhood tuberculosis. As use of the BCG vaccine in adults becomes more prevalent to potentially treat or mitigate certain disorders, it is imperative that health care providers recognize the potentially severe side effects associated with its use.

Cutaneous Manifestations of Mycobacterium tuberculosis: A Literature Review

“…Most recipients of the BCG vaccine report a benign and localized skin reaction after administration, although there is a risk for more serious cutaneous side effects such as fistulation, abscess formation, and ulceration. Even rarer, a tuberculous chancre can form with inoculation of M. bovis to the skin after local trauma, and this accounts for about 1–2% of CTB [ 52 ]. Multiple reports have been published describing the extremely rare development of a CTB reaction after the administration of the BCG vaccination [ 17 ].…”

“…Dhar et al describe a previously healthy 4-month-old diagnosed with biopsy-confirmed disseminated CTB at the site of BCG immunization that resolved without recurrence after anti-TB treatment [ 17 ]. A case report conducted by Stratmen et al described an adult developing chancre-variant CTB in response to receiving the BCG vaccine for the treatment of fibromyalgia [ 52 ]. The patient underwent surgical debulking of the chancre as well as 6 months of Isoniazid monotherapy, and the complication resolved.…”

Cutaneous tuberculosis in the pediatric population: A review

“…Similarly, on histology, granulomatous dermatitis is present, and staining for Mycobacteria bovis is positive. 34 Surgical debulking of the area may be necessary in addition to 6 months of anti-tuberculosis drugs. 34 …”

“… 34 Surgical debulking of the area may be necessary in addition to 6 months of anti-tuberculosis drugs. 34 …”