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Osteomyelitis of the humerus complicating BCG vaccination

¹ Dept of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford, UK
² Dept of Radiology, University of Oxford, John Radcliffe Hospital
³ Dept of Orthopaedics, Nuffield Orthopaedic Centre, Oxford, UK
⁴ Dept of Medicine, University of Oxford, John Radcliffe Hospital
⁵ Dept of Paediatrics, Wexham Park Hospital, Slough, UK

Correspondence to:
Correspondence to:
Dr S Segal
Department of Paediatrics, University of Oxford, Level 4, John Radcliffe Hospital, Oxford OX3 9DU, UK; shelley.segal@paediatrics.ox.ac.uk

Keywords: BCG; mycobacteria; osteomyelitis

The first 150 words of the full text of this article appear below.

An 18 month old boy presented with reluctance to move his left arm after a fall. He had received bacille Calmette-Guérin (BCG) vaccination six months prior to presentation. Radiological examination of the humerus showed a proximal pathological fracture and a number of lytic lesions. Magnetic resonance imaging showed an aggressive lesion within the proximal metaphysis with cortical disruption.

A bone biopsy showed inflammatory tissue containing Langhan’s giant cells and granulomatous inflammatory infiltrate. Surgical washout and debridement removed large amounts of caseous material from the bony cavity. MTB ELISPOT was negative and PPD ELISPOT positive, confirming the diagnosis of BCG osteomyelitis.

Although BCG is generally well tolerated, some serious adverse reactions can occur.¹ The most frequent complications are local subcutaneous abscess or suppurative regional lymphadenitis. The factors responsible for BCG complications include the vaccine strain, faulty intradermal technique, and overdose.¹ Fatal disseminated disease has been described in congenital or acquired disturbances . . . [Full text of this article]