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. 2021 Aug 11;21(1):801.
doi: 10.1186/s12879-021-06531-8.

The role of surgical management of BCG vaccine-induced regional suppurative lymphadenitis in children: a 7 years' experience from one medical center

Chen Liu  1 , Minxiang Huang  1 , Fang Liu  2 , Xiaoliang Xu  1 , Wenyu Feng  1 , Guoxiu Han  1 , Xijie Liu  1 , Bufeng Zheng  1 , Lei Geng  3 , Tingliang Fu  1
Affiliations

The role of surgical management of BCG vaccine-induced regional suppurative lymphadenitis in children: a 7 years' experience from one medical center

Chen Liu et al. BMC Infect Dis. .

Abstract

Background: The management strategy of Bacille Calmette-Guérin (BCG) vaccine-induced regional suppurative lymphadenitis in children is still controversial and more clinical studies are needed. We therefore present a surgical case series to explore the role of surgical management for this dilemma.

Methods: From January 2013 to June 2020, data from 65 patients diagnosed with BCG vaccine-induced regional suppurative lymphadenitis were retrospectively reviewed. Clinical characteristics, ultrasonographic findings, surgical procedures, perioperative management, and outcome were analyzed. The association between postoperative seroma and symptom duration, skin involvement, and postoperative hospital stay were compared using Yates's corrected Chi-square test and Student's t-test for statistical analysis. The follow-up period ranged from three to six months.

Results: Of the 65 cases, the median age at presentation was 3.4 months. All patients were full-term with normal range of birth weight and received a BCG vaccination in the first 24 h of life. All patients underwent surgical excision of the abscess with the involved lymph node(s). Postoperative seroma formation was found in 20 patients and fine needle aspiration was needed. There was no significant association between postoperative seroma formation with symptom duration, skin involvement, and postoperative hospital stay. No oral anti-tubercular agents were given postoperatively. The mean length of postoperative hospital stay was 6.02 ± 1.62 days. Sixty-four cases (98.46%) received only one procedure and recovered. One patient required a second procedure due to postoperative sinus.

Conclusions: The present study showed that surgical excision of the abscess with involved lymph node(s) is one of the choices for BCG vaccine-induced suppurative lymphadenitis, but special attention should be paid to controlling the surgical indications. Intraoperative meticulous manipulation and postoperative care are crucial to achieve a good outcome.

Keywords: Adverse reaction; Bacille Calmette-Guérin vaccine; Children; Regional suppurative lymphadenitis; Surgical management.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Appearance of the mass with skin involvement in the left axillary and chest wall
Fig. 2
Fig. 2
Gross appearance of the excised specimen. a Enlarged lymph nodes with abscess formation. b Subcutaneous abscess, proliferative and suppurating lymph nodes (in sectional view)
Fig. 3
Fig. 3
Flow chart for the management of BCG vaccine-induced regional lymphadenitis
See this image and copyright information in PMC

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