Bacille Calmette-Guérin osteomyelitis

Document Type : SHORT COMMUNICATION

Authors

1 Mashhad University of medical sciences

2 Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

 
Background: Tuberculosis is an essential problem for healthcare systems especially in developing countries . All newborns are given Bacillus Calmette-Guérin (BCG) vaccine in Iran which is prepared from live bovine tuberculosis bacillus, and is given to protect against tuberculosis. Osteomyelitis secondary to BCG vaccination is rare and usually involves epiphysis of long tubular bones.
Methods: 4 patients, 3 males and a female entered this study and were between 11 to 24 months old. The involved bones were first metatarsi, talus, humerus and tibia bone. The main radiologic finding was lytic lesion with cortical destruction and periosteal reaction.
Results: 3 patients underwent core needle biopsy and the one with the proximal tibia involvement, underwent open surgery. Pathology report suggested granulomatous osteomyelitis and typical caseous necrosis compatible with tuberculosis. Surgical treatment for these patients was curettage and debridement of the bone lesion and involved tissues around. The patients got standard anti TB pharmacotherapy, were completely cured and no short term complication was seen in a one year follow up.
Conclusion: BCG osteomyelitis and cold abscess, should be kept in mind when assessing a child presenting chronic symptoms like pain, limping or local swelling of extremities. The long interval time between BCG vaccination and outbreak of the culture-negative abscess is a major point which emphasizes on pathologic evaluation. Imageguided tissue biopsy and PCR studies confirm diagnosis. Early use of a surgical curettage and debridement along with chemotherapy soon afterwards, enabled these children to enjoy a satisfactory clinical outcome.

Keywords

References

  1. References

    1. Aribasa OK, Kanatb F, Gormusc N, Turk E. Cold abscess of the chest wall as an unusual complication of BCG vaccination. Eur J Cardiothorac Surg. 2002; 21(2):352–4.
    2. Lugosi L. Theoretical and methodological aspects of BCG vaccine from the discovery of
    3. Calmette and Guerin to molecular biology: A review. Tuber Lung Dis. 1992; 73(5):252-61.
    4. Hengster P, Solder B, Fille M, Menardi G. Surgical treatment of bacillus Calmette Guerin lymphadenitis. World J Surg. 1997; 21(5):520–3.
    5. Talbot EA, Perkins MD, Silva SF, Feothingham R. Disseminated bacille Calmette-Guerin disease after vaccination: Case report and review. Clin Infect Dis. 1997; 24(6):1139–46.
    6. Brewer TF. Preventing tuberculosis with bacillus Calmette-Guerin Vaccine: a meta-analysis of the literature. Clin Infect Dis. 2000; 31(Suppl 3):S64–7.
    7. Chan PK, Ng BK, Wong CY. Bacille Calmette-Guérin osteomyelitis of the proximal femur. Hong Kong Med J. 2010; 16(3):223-6.
    8. Geissler W, Pumberger W, Wurnig P, Stuhe O. BCG osteomyelitis as a rare case of mediastinal tumor in a one-year-old child. Eur J Pediatr Surg. 1992; 2(2):118–21.
    9. Simila S, Liedes E, Kinnunen P. Sternal abscess as a complication of BCG-revaccination. Tubercle. 1988; 69(1):67–9.
    10. Bergdahl S, Felländer M, Robertson B. BCG osteomyelitis: experience in the Stockholm region over the years 1961-1974. J Bone Joint Surg Br. 1976; 58(2):212-6.
    11. Berges O, Boccon-Gibod L, Berger JP, Fauré C. Case report 165: BCG-osteomyelitis of the proximal end of the humerus with an abscess dissecting into the deltoid muscle. Skeletal Radiol. 1981; 7(1):75-7.
    12. Erikson U, Hjelmstedt A. Roentgenologic aspects of BCG osteomyelitis. Radiology. 1971; 101(3):575-8.
    13. Vohra R, Kang HS, Dogra S, Saggar RR, Sharma R. Tuberculous osteomyelitis. J Bone Joint Surg Br. 1997; 79(4):562-6.
    14. Kröger L, Korppi M, Brander E, Kroger H, Wasz-Hockert O, Backman A, et al. Osteitis caused by bacille Calmette-Guérin vaccination: a retrospective analysis of 222 cases. J Infect Dis. 1995; 172(2):574-6.
    15. Sharifi SR, Ebrahimzadeh MH, Ahmadzadeh-Chabok H,  Khajeh-Mozaffari J. Closed total talus dislocation without fracture: a case report. Cases J. 2009; 2:9132.
The Archives of Bone and Joint Surgery
Volume 3, Issue 4 - Serial Number 4
October 2015
Pages 291-295

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History

  • Receive Date: 28 April 2015
  • Revise Date: 30 August 2015
  • Accept Date: 13 September 2015

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