ABSTRACT
Bacillus Calmette-Guérin (BCG) local scar inflammatory reactions have been mostly associated with Kawasaki disease in children and less commonly with other viral infections (i.e., measles). BCG scar inflammation associated with or following vaccine administration has only been reported with the influenza vaccine. We describe the first reports in the literature of local BCG inflammation following two different available messenger ribonucleic acid (mRNA) anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) vaccines (mRNA-1273, and BNT162b2) in two young healthy physicians, one from Costa Rica, and another from the United States of America, with normal cell blood counts, flow cytometries, and negative for human immunodeficiency virus (HIV). In both cases, BCG scar inflammation appeared after 24 hours of vaccination of the second dose, without signs of reaction on the injection site, and resolved within four days. Dermoscopic findings in one case showed arborizing and comma-shaped vessels. Pharmacovigilance surveillance of BCG scar reactions following coronavirus disease 2019 (COVID-19) vaccines should be considered particularly in countries where BCG is part of their national immunization programs.
ABSTRACT
BACKGROUND: Pediatric mycotic infections in the eye are uncommon. However, ophthalmic infections by several fungal species have been described in immunocompetent subjects. Mycotic keratitis with or without conjunctivitis (MK) may account for more than 50% of all cases, particularly in tropical and sub-tropical areas. The leading mechanism is trauma. Treatment of MK is managed by medical (antifungal agents) and/or surgical means. This is the first case report of a patient with MK by Fusarium spp. successfully treated with keratoplasty and intravenous voriconazole, along with topical natamycin. METHODS: Keratoplasty was performed and cultures obtained. Both Blood and Sabouraud Agars were used for cultures, and Lactophenol Cotton Blue Staining for microscopic observation. RESULTS: A healthy, 10 year-old female, from the sub-tropical area of Sinaloa, Mexico, was admitted at both the CODET Vision Institute and the General Hospital of Tijuana, Mexico. Seven days after a direct trauma of the right cornea, the patient complained of progressive blurred vision, burning sensation, and itchiness. Clinical examination showed severe keratoconjunctivitis, and a necrotic slough on the cornea. Fungal colonies grew, and microscopic visualization showed typical ovoid, sickle-cell shaped macroconidia characteristics of Fusarium spp. The patient received intravenous voriconazole (200 mg every 12 h) and topical natamycin for 7 days prior and 6 days after keratoplasty. Topical natamycin was continued for 3 weeks. At 1-month follow-up, the patient's outcome was significantly improved, with 90% vision recovery. CONCLUSION: This is the first pediatric case report of severe MK by Fusarium spp. successfully treated with combined intravenous voriconazole, keratoplasty and topical natamycin.
