Enfermedad por bacilo de Calmette-Guérin a distancia en un lactante: Presentación de un caso / Distant bacillus Calmette-Guérin disease in an infant: Case report

La vacuna con el bacilo de Calmette-Guérin es una vacuna atenuada utilizada para prevenir formas graves de tuberculosis. Se aplica a los recién nacidos en países con alta prevalencia de tuberculosis. Pueden presentarse, después de su aplicación, complicaciones a nivel local, como supuración o adenopatías regionales. La enfermedad por diseminación del bacilo es infrecuente y ocurre, por lo general, en pacientes con alteraciones inmunitarias subyacentes. Se presenta el caso de un niño de 5 meses que ingresó por un cuadro de 2 meses de evolución con detención del aumento de peso y nódulos subcutáneos. Se sospechó enfermedad por diseminación del bacilo y se diagnosticó por la biopsia de las lesiones. Se realizó el tratamiento con tres drogas antituberculosas, y se recuperó clínicamente. Si bien se realizaron estudios inmunológicos, no logró demostrarse ninguna inmunodeficiencia como afección predisponente.

The bacillus Calmette-Guérin vaccine is an attenuated vaccine historically used to prevent severe forms of tuberculosis. It is applied to all newborns in countries with high prevalence of tuberculosis. Local complications, such as suppuration or regional adenopathies, may occur after application. Disease due to the spread of the bacillus is infrequent, usually occurring in a patient with an underlying immune alteration. We present the case of a 5-month-old child who was admitted due to a 2-month evolution with weight loss and subcutaneous nodules. Disease was suspected to be due to bacillus Calmette-Guérin dissemination, being diagnosed by biopsy of the lesions. Treatment was carried out with three antituberculous drugs, evolving towards clinical recovery. Although immunological studies were carried out, no immunodeficiency could be demonstrated as a predisposing condition.

A Case of Chronic Mucocutaneous Candidiasis Occurring in a Patient with Scrofuloderma-like BCGitis / 대한의진균학회지

Chronic mucocutaneous candidiasis (CMC) consists of several clinical syndrome characterized by chronic, treatment-resistant, superficial candidal infections of skin, nails and oropharynx. The patients with CMC usually have other manifestations including non-candidal infections, endocrinopathies and autoimmune diseases. These findings suggest that patients with CMC have multiple or complex abnormalities in their immune systems, especially of cell mediated immunity. The scrofuloderma or scrofuloderma-like BCGitis is used to describe the skin reaction and enlargement of regional lymph node with suppuration. In contrast to chronic mucocutaneous candidiasis, BCGitis does not suggest underlying host immune defect in most cases. In our knowledge, there is no report about scrofuloderma-like BCGitis and chronic mucocutaneous candidiasis occurring in the same patient. Herein, we report a case of chronic mucocutaneous candidiasis associated with scrofuloderma-like BCGitis.

Tubercular disease caused by bacillus of Calmette-Guerin administered as a local adjuvant treatment of relapsing bladder carcinoma: Pathogenetic, diagnostic and therapeutic issues, and literature review

Two exemplary case reports of respiratory granulomatous infection caused by bacillus of Calmette-Guérin (BCG) in patients who were repeatedly treated with local, intravesical adjuvant BCG therapy for a relapsing transitional bladder carcinoma, are outlined and discussed, on the ground of the cumbersome diagnostic and differential diagnostic process (especially when a prior tuberculosis and a concurrent chronic obstructive pulmonary disease are of concern), and an updated literature revision. Only four cases of respiratory BCG-itis (pulmonary tuberculosis-like forms), have been reported until now to the best of our knowledge (two of them following bladder instillation of BCG). One episode of ours represents the first described case with a dual, concomitant granulomatous localization of BCG-itis, also involving the genitourinary tract

A Case of Scrofuloderma-like BCGitis Near the BCG Vaccination Sit / 대한피부과학회지

A 10-month-old male patient was seen with a nodular lesion on his left upper arm which developed several months after BCG vaccination. Physical examination revealed a bean sized, irregular surfaced, erythematous pustular nodule on the left upper arm at a place different from the vaccination site. Histopathologic examination of the nodule on the left upper arm showed tubercles composed of mononuclear cells, epithelioid cells and langhans type giant cells in the dermis. Caseation necrosis within the typical tubercles was noted. Prominent improvement of the lesion was observed 4 months after oral medication with isoniazid and rifampicin.

A Case of Generalized Granuloma Annulare Following BCG Vaccination / 대한피부과학회지

Generalized granuloma annulare is defined as affecting at least the trunk and either the upper or lower extremities, or both. It is represented by disseminated necrobiotic dermal papules forming annular or nonannular configuration. Clinical associations between generalized granuloma annulare and diabetes mellitus, thyroid disease, malignancy, infection, and vaccination have been reported. BCG vaccination induces specific and nonspecific dermatologic complications such as scrofuloderma-like, lupus vulgaris-like, tuberculid, urticaria, erythema multiforme, erythema nodosum, and granuloma annulare. Generalized granuloma annulare associated with BCG vaccination or tuberculin test has not been reported in the Korean literature. Herein, we report a case of generalized granuloma annulare which occurred in a 6-month-old boy following BCGitis on the BCG vaccination site.

A Case of Papular Tuberculid and BCGitis after BCG Vaccination / 대한피부과학회지

BCG (Bacillus Calmette-Guerin), which produces resistance to tuberculosis infection, is a vaccine containing live, attenuated Mycobacterium bovis. It induces specific and nonspecific dermatologic complications. The specific reactions include scrofuloderma-like, lupus vulgaris-like, lichen nitidus-like, lymphadenitis and tuberculid. We report a case of papular tuberculid, which was presented as 3-5mm sized erythematous papules on the extremities and face, and BCGitis had developed around the vaccination site after BCG vaccination. Histopathologic examination of the papule and lymph node showed granuloma, consisting of epithelioid cells and lymphocytes.

Three Cases of Scrofuloderma-like BCGitis Showing Spontaneous Remission / 대한피부과학회지

BCG(Bacillus Calmette-Guerin) is a vaccine from living attenuated Mycobacterium bovis which produces resistance to tuberculous infection. It induces specific and nonspecific dermatologic complications on the vaccination site or out of the site. The specific reactions include lymphadenitis, scrofuloderma-like, lupus vulgaris-like, lichen nitidus-like and tuberculid. On the contrary, nonspecific reactions such as toxicoderma hemorrhagica, urticaria, erythema multiforme, erythema nodosum and granuloma annulare have also been reported. Among them the term BCGitis is used to describe the skin reaction and enlargement of the regional lymph node, with or without suppuration. We present three cases of BCGitis developed around the vaccination site after BCG vaccination with spontaneous remission within 2~6 months. Histopathologic examination respectively showed foci of palisading granuloma with central caseation necrosis and surrounding lymphohistiocytic infiltration.