Purpose or Case Report: Mycobacterium bovis BCG osteitis, a rare complication of BCG vaccination. The aims of this study were to evaluate the clinical and imaging characteristics of BCG osteitis.
Methods & Materials: Twenty children with BCG osteitis at the Seoul National University Children’s Hospital from January 2007 to March 2018 were included [M:F=13:7, median age at symptom onset:15 months (range: 7-34 months)]. M. bovis BCG osteitis was confirmed by multiplex PCR in the affected bone. BCG immunization status, clinical information, radiological findings [plain radiography and MRI (all), ultrasonography (n=9), and CT (n=1)] were reviewed retrospectively.
Results: Most common presenting symptoms were soft tissue swelling and pain (n=13, 65%) while fever was accompanied only in three patients (15%). Median duration of symptom was 1 month (range: 2 days-3 months). Leukocytosis and elevation of C-reactive protein (CRP, > 0.5 mg/dL) were depicted in three (15%) and seven patients (35%), respectively. Sixteen children (80%) received Tokyo-172 vaccine by percutaneous multiple puncture method, three (15%) and one (5%) received intradermal Tokyo-172 and Danish strain, respectively. Distal femur (n=7) was the most frequently involved site followed by tarsal bones (n=4), proximal tibia (n=2), distal humerus (n=1), distal radius (n=1), sternum (n=1), rib (n=1) and proximal phalanx of big toe (n=1). Epiphyseal involvement of the long tubular bones were seen in seven patients (35%). Multiple bone lesions were depicted in two patients. Plain radiography showed ill-defined osteolytic lesion with cortical disruption in 13 patients. MRI showed central necrosis in the involved marrow cavity with cortical destruction and cold abscess formation in 14 patients (70 %). Surgical drainage was performed in 19 patients (95%), and half of them required repeated surgical interventions due to recurrent infection. Antituberculosis medications were administered for a median duration of 12 months (range, 12-31 months).
Conclusions: BCG osteitis in immunocompetent children is a rare but serious complication of BCG immunization. High level of suspicion of BCG osteitis based on clinical and radiological manifestations is important for early diagnosis and prompt management.