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A 3 month old, otherwise well baby of Chinese origin, who had received BCG vaccine in the left deltoid region on the second day of life, presented with a one month history of a lump in the left axilla (see fig). Examination revealed a fluctuant mass (5×8 cm) at the left anterior axillary fold. Ultrasonography confirmed enlarged but non-suppurative lymph nodes. A presumptive diagnosis of BCG lymphadenitis was made and treatment was started with isoniazid. A month later the swelling increased in size and became more fluctuant. Surgical incision and drainage was performed, which revealed caseous material characteristic of tuberculous infection.
Isoniazid was continued for a total of three months and the lesion healed uneventfully.
On a prolonged culture, Bacille Calmette-Guerin was grown that was resistant to isoniazid but sensitive to ciprofloxacin, ethambutol, and rifampicin.
Although BCG lymphadenitis is a well recognised condition, it is not commonly seen in UK district general hospitals. Treatment of BCG lymphadenitis remains controversial. In one series,1 surgery was proposed as the most effective treatment in advanced cases with no reported recurrence or fistula formation. Goraya and Virdi,2 however, suggested that no treatment was required in non-suppurative lymphadenitis. In the case of suppuration, surgical treatment either by needle aspiration or surgical excision could be undertaken. In our case, treatment with isoniazid was probably non-contributory.
We wish to thank the parents of the infant presented in this case report who gave their permission for this case report to be written.
Dr Mohammed Al Moudaris died after a short illness on 15th April 2004. For 13 years he had been a general paediatrician with a special interest in allergy at the Hospital of St. Cross, Rugby and Walsgrave Hospital, Coventry. He was a very popular member of staff and will be sadly missed by patients and colleagues. He leaves a wife, Nudhar Hadid (a consultant radiologist with the same Trust), a daughter, May (an architect), and a son, Al, who graduated as a doctor this summer.