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Case Reports
. 2023 Jun 20;2023(6):rjad362.
doi: 10.1093/jscr/rjad362. eCollection 2023 Jun.

Bacillus Calmette-Guérin osteomyelitis of the fifth metatarsal bone in a Japanese infant: a case report

Shota Morimoto  1 , Tomoya Iseki  1 , Toshiya Tachibana  1 , Hiroyuki Futani  1
Affiliations
Case Reports

Bacillus Calmette-Guérin osteomyelitis of the fifth metatarsal bone in a Japanese infant: a case report

Shota Morimoto et al. J Surg Case Rep. .

Abstract

Bacillus Calmette-Guérin osteomyelitis is a rare complication following Bacillus Calmette-Guérin vaccination. Here, we describe a rare case of Bacillus Calmette-Guérin osteomyelitis of the fifth metatarsal in a 21-month-old Japanese infant. A 21-month-old Japanese female infant presented with a swollen mass on the dorsolateral aspect of the left foot. Based on physical examination, radiological and histopathologic findings and laboratory results, a diagnosis of Bacillus Calmette-Guérin osteomyelitis of the fifth metatarsal bone was made, and an oral anti-tuberculosis treatment was initiated. However, the mass recurred 10 months after the start of the anti-tuberculosis treatment, so additional surgical debridement was performed. Six months after surgery, clinical findings and plain radiograph images revealed complete improvement of the affected area, and anti-tuberculosis treatment was stopped. Bacillus Calmette-Guérin osteomyelitis of the fifth metatarsal in a 21-month-old Japanese infant was successfully treated with oral anti-tuberculosis therapy and surgical debridement.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The mass, ~3 × 3 cm, was located on the dorsolateral aspect of the left foot and was hard accompanied by local heat.
Figure 2
Figure 2
Plain radiographs of the left foot showing a lytic lesion without periosteal reaction in the fifth metatarsal bone in (A) anteroposterior and (B) oblique views.
Figure 3
Figure 3
MRI showed an isointense lesion on T1-weighted images and a hyperintense lesion on T2-weighted images around and within the fifth metatarsal.
Figure 4
Figure 4
Gallium scintigraphy revealed intense uptake in the patient’s left foot.
Figure 5
Figure 5
(A) The lesion was yellow and consisted of weak, adipose-like tissue that surrounded and continued into the inferior of the fifth metatarsal bone; (B) The lesion inside and outside the bone was resected as much as possible.
Figure 6
Figure 6
The histopathologic examination of the lesion showed granulomatous inflammation including anaplastic giant cells; (A) Langerhans-type giant cells (white arrow) and (B) Caseous necrosis (white arrow).
Figure 7
Figure 7
Plain radiographs of the left foot showed the lytic lesion of the fifth metatarsal was remodeled gradually in (A) anteroposterior and (B) oblique views.
Figure 8
Figure 8
MRI revealed that a high-intensity lesion remained around and inside the fifth metatarsal on T2-weighted fat-suppressed images.
Figure 9
Figure 9
At 6 months after the second surgery, image findings on plain radiographs completely improved on (A) anteroposterior and (B) oblique views.
See this image and copyright information in PMC

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