Sternal Osteomyelitis after Bacillus Calmette-Guérin Vaccination

Abstract

Presented here is the case of a nine-month-old boy with the osteomyelitis of the upper area sternum caused by bacillus Calmette-Guerin (BCG), the Danish 1331 strain vaccine against tuberculosis. Upon examination, a swelling of approximately 2×3 cm diameter was observed in the upper sternal area. The mass was hard, fixed and sensitive to palpation with no local skin hyperaemia. Chest X-rays revealed a round mass anterior to the sternum, suggesting a diagnosis of osteomyelitis. A consequent sternal biopsy was performed and Mycobacterium bovis BCG was identified by a positive growth culture.

Case Reports of Bacillus Calmette-Guérin (BCG) Osteomyelitis: A Rare Complication in Immunocompetent Infants

“…It can occur at the site of vaccine injection (the left upper arm as per the standard) as seen in our second case or at a distant site as in our first and third patient. The latter may indicate hematogenous dissemination of Mycobacterium bovis [ 5 - 6 ]. It also commonly affects extremities more than axial bones [ 1 , 4 ], and around 80% occur at metaphysis or epiphysis of long bones when extremities are affected [ 4 ], as supported by our findings.…”

Vaccine-induced tuberculous osteomyelitis

“…Bone infections are one of the rarest vaccine complications [3] BCG and TB osteomyelitis are sometimes indistinguishable entities [4]. 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].…”