Lupus vulgaris in a child following BCG immunization

Kökçam, İbrahim; Köse, Ahmet; Yekeler, Hayrettin; Doymaz, Mehmet Ziya

doi:10.1046/j.1440-0960.2001.00534.x

Cited by 13 publications

(10 citation statements)

References 4 publications

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“…It may also be acquired exogenously following secondary inoculation tuberculosis by BCG vaccination. It is more common in females than in males, with all age groups equally affected 11 . Its well‐demarcated reddish‐brown plaques, often seen in the head and neck region, display deep‐seated nodulation assuming a yellowish brown or “apple‐jelly” coloration when diascopic examination compression removes their blood.…”

Section: Discussionmentioning

confidence: 99%

Lupus vulgaris: report of two cases

et al. 2005

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Although there has been a steady decline in the incidence of tuberculosis in recent years, it persists in some regions, and where AIDS is especially prevalent, the number of new cases has been increasing. Thus, cutaneous tuberculosis has re-emerged in areas with a high incidence of HIV infection and multidrug-resistant pulmonary tuberculosis. Lupus vulgaris has been and remains the most common form of cutaneous tuberculosis. Cutaneous manifestations of disseminated tuberculosis are unusual, being seen in less than 0.5% of cases. Scrofuloderma, tuberculosis verrucosa cutis and lupus vulgaris comprise most cutaneous tuberculosis cases. Bacillus Calmette-Guerin (BCG) is derived from an attenuated strain of Mycobacterium bovis and is employed beneficially as a relatively safe vaccination in Poland and other countries in which the prevalence of tuberculosis is high. However, BCG vaccination may produce complications, including disseminated BCG and lupus vulgaris, the latter seen in one of our two patients in whom lupus vulgaris at the inoculation site followed a second vaccination with BCG 12 years after the initial one. A similar phenomenon has been described after immunotherapy with BCG vaccination. Re-infection (secondary) inoculation cutaneous tuberculosis may also occur as a result of BCG vaccination, producing either lupus vulgaris or tuberculosis verrucosa cutis, probably depending upon the patient's degree of cell-mediated immunity. However, most lupus vulgaris cases are not associated with vaccination with BCG, as occurred in our first patient. For those who do develop lupus vulgaris, it can be persistent for a long period, in some cases for many decades. In the second patient we describe a lengthy duration and cutaneous reactivation at distant sites after more than 40 years.

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Section: Discussionmentioning

confidence: 99%

Lupus vulgaris: report of two cases

et al. 2005

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“…Virulence of organism, amount of inoculum, technical errors and genetic susceptibility may affect on BCG-related LV (4). Lupus vulgaris develops few weeks to 8 years after BCG vaccination and mean duration for BCG-induced LV is one year (6,9). The largest reported size of LV lesion is 60 × 45 cm (10).…”

Section: Discussionmentioning

confidence: 99%

Bacillus Calmette-Guerin Vaccine-Induced Lupus Vulgaris in a Child With Trisomy 9

Movahedi

Sotoudeh

Mamishi

et al. 2016

Arch Pediatr Infect Dis

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Introduction: Lupus vulgaris (LV) is one type of cutaneous Tuberculosis (TB) but a rare complication of (BCG) vaccination. Case Presentation: We report a 13-month-old boy with trisomy 9 who developed LV on his right arm with extension to anterior part of the chest one month after BCG vaccination. Culture and Gram stain was negative for mycobacteria. The diagnosis was confirmed by clinical and histopathological correlation and eventually Mycobacterium bovis was detected in tissues using the Polymerase Chain Reaction (PCR) method. The patient was treated with isoniazid, rifampin and ethambutol. Two months after drug therapy, marked improvement was developed. Conclusions: Post immunization LV is a rare complication of the BCG vaccine and should be considered by any physician. Lupus vulgaris is a paucibacillary form of TB. Therefore, acid fast bacilli are not detected in most cases. The PCR is a useful method for confirmation of the diagnosis of LV.

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“…This lesion can evolve to lupus vulgaris or tuberculosis verrucosa cutis if left untreated. In the literature, cutaneous tuberculosis by exogenous infection has been reported after vaccination with bacillus Calmette–Guérin (BCG), 3 tattoos, 4 piercings, 5 circumcision, 6 mouth‐to‐mouth resucitation, 7 injections and cuts with knives, 8 and in healthcare workers 9 . In this group of professionals, accidents during autopsies and accidents involving paramedical personnel during the care of patients or in the laboratory have been reported 10,11 .…”

Section: Discussionmentioning

confidence: 99%

Primary cutaneous inoculation tuberculosis in a healthcare worker as a result of a surgical accident

Tapias

Tapias-Vargas

2008

Int J Dermatology

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In May 2004, a 48-year-old male surgeon, resident in Bucaramanga, Colombia, suffered a superficial cut with a scalpel to the lateral aspect of the mid-phalanx of the second finger of the left hand while performing a pulmonary decortication surgical procedure for tuberculous empyema with pulmonary entrapment. The injury healed normally but, approximately 2 weeks after the event, an erythematous, nonpainful papule of approximately 3 mm in diameter developed, and increased progressively to 7 mm 3 days after its initial appearance. At this time, the papule showed spontaneous secretion of a clear liquid and superficial ulceration (Fig. 1). Approximately 3 weeks after the injury, a Gram stain of the liquid was performed; it showed no bacteria but a moderate leukocyte reaction. Because of the high suspicion of possible tuberculous infection, bacilloscopy of the liquid was performed, and was positive (++) for acid-fast bacteria (Fig. 2). The liquid was cultured and grew Mycobacterium tuberculosis. The culture was sent to the Laboratory of Mycobacteria at the National Institute of Health, Bogota, Colombia for drug resistance testing. Susceptibility was demonstrated against streptomycin, isoniazid, rifampicin, and ethambutol. During this time, the patient presented an ipsilateral painful axillary adenopathy of about 2.5 cm in diameter. The patient consulted with an infectologist, who initiated a Directly Observed Therapy Short Course (DOTS) regimen [first phase (8 weeks): daily, except Sundays, streptomycin 1 g intramuscularly, pyrazinamide 1500 mg orally, isoniazid 300 mg, and rifampicin 600 mg; second phase (18 weeks): twice weekly rifampicin 600 mg and isoniazid 500 mg], accompanied by daily pyridoxine to prevent secondary effects from isoniazid. After 3 weeks of treatment, the finger lesion had disappeared. Treatment was undertaken as described above, with the patient reporting symptoms of vertigo, nausea, epigastralgia, and mild myalgia as the adverse effects of medication. A chest x-ray was taken and reported to be normal. The axillary adenopathy disappeared approximately 6 months after the injury. Nearly 3.5 years after the incident, the patient has not presented any type of symptomatology.

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Lupus vulgaris in a child following BCG immunization

Abstract: A three year old girl presented with lupus vulgaris of the upper arm, which appeared 1 month after BCG immunization. The diagnosis was confirmed by polymerase chain reaction after histology and culture were negative for mycobacteria. Complete healing followed 6 months of oral isoniazid.

Cited by 13 publications

References 4 publications

Lupus vulgaris: report of two cases

Lupus vulgaris: report of two cases

Bacillus Calmette-Guerin Vaccine-Induced Lupus Vulgaris in a Child With Trisomy 9

Primary cutaneous inoculation tuberculosis in a healthcare worker as a result of a surgical accident

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