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Images in paediatrics
BCG induced lupus vulgaris: an unexpected adverse event
  1. Elaine Pace Spadaro1,
  2. John Xuereb Dingli2,
  3. Rainer Doffinger3,
  4. Kumararatne Dinakantha3,
  5. Alexandra Betts4,
  6. David Pace1
  1. 1 Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
  2. 2 Gozo General Hospital, Gozo, Malta
  3. 3 Department of Clinical Biochemistry and Immunology, Addenbrooke’s Hospital, Cambridge, UK
  4. 4 Department of Histopathology, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Elaine Pace Spadaro, Department of Child & Adolescent Health, Mater Dei Hospital, Tal-Qroqq, Msida MSD2090, Malta; elaine.pace-spadaro{at}

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A 12-year-old boy presented with a slowly enlarging plaque, at the site of BCG vaccination (Statens Serum Institute, Danish strain 1331), administered 14 months previously (figure 1). Mantoux testing showed a 14 mm induration and his interferon-gamma (IFN-γ) release assay was negative. Skin biopsy revealed non-caseating dermal granulomata composed of epithelioid histiocytes and Langhans-type multinucleated giant cells (figure 2). No acid fast bacilli were seen. PCR for Mycobacterium tuberculosis complex (includes M bovis) was negative. Based on a clinical diagnosis …

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