Osteitis of the radius following Bacillus Calmette–Guérin vaccination at birth: a case report

Abstract

BackgroundThe Bacillus Calmette–Guérin vaccine, which is used for the prevention of tuberculosis, is considered protective against the severe forms of childhood tuberculosis. However, some serious adverse reactions including osteitis of the long bones can occur.Case presentationWe report a case of an 18-month-old Sudanese girl who presented at the age of 3 months with swelling of her left forearm following Bacillus Calmette–Guérin vaccination administered at birth. Radiological and histological investigations confirmed tuberculous osteitis of the distal radius. She responded very well to antituberculous treatment with complete healing at follow-up visits. To the best of our knowledge this is the first case report of osteitis of the radius following Bacillus Calmette–Guérin vaccination described from Sudan.ConclusionsBacillus Calmette–Guérin osteitis, although rare, should be considered a possible complication of the Bacillus Calmette–Guérin vaccination, and early diagnosis and treatment are essential.

The sixty‐year story of Finnish Bacillus Calmette‐Guérin (BCG) osteitis

“…Interestingly, the study from Thailand reported, in addition to five localised BCG osteitis cases, also three cases with disseminated BCG infection, and two of them had severe combined immunodeficiency and one had Wiskott-Aldrich syndrome. 8 Thus, the systematic review, 2 and the basic and outcome data of the 222 Finnish BCG osteitis patients 3,4,21,25 and the data of the 93 new patients included in the present review [5][6][7][8][9][10] confirm that there are no major immunological problems in the BCG osteitis patients, if the infection is not disseminated, and if multiple or recurrent lesions are not present.…”

“…BCG osteitis cases which were reported from 2013 to June 2019 were searched in PubMed using the terms ‘BCG osteitis’, ‘BCG osteomyelitis’ and ‘BCG vaccination complications’. Six reports including 102 patients were found: one case from France, 5 one case from Sudan, 6 21 cases from Korea, 7 five cases from Thailand, 8 three cases from Mexico 9 and 71 cases from Taiwan 10 . Nine of the BCG osteitis cases reported in 2013‐2019 were already included, and 93 were not included in the systematic review published in 2015 2 .…”

“…24 The systematic review included only immunocompetent children with BCG osteitis, 2 and the additional 93 patients included in the present review had no clinical or laboratory evidence on immune deficiencies. [5][6][7][8][9][10] Since the reports were either retrospective chart reviews or case presentations, the extent and quality of immunological studies were variable. Interestingly, the study from Thailand reported, in addition to five localised BCG osteitis cases, also three cases with disseminated BCG infection, and two of them had severe combined immunodeficiency and one had Wiskott-Aldrich syndrome.…”

“…The systematic review included only immunocompetent children with BCG osteitis, 2 and the additional 93 patients included in the present review had no clinical or laboratory evidence on immune deficiencies 5‐10 . Since the reports were either retrospective chart reviews or case presentations, the extent and quality of immunological studies were variable.…”