Disseminated BCG infection revealing a severe combined immunodeficiency: A case report

Abstract

Introduction: Bacillus Calmette Guerin (BCG) vaccine, which is administered to all newborns in Tunisia, can lead to serious complications ranging from local disease to disseminated disease in a group of patients with primary immunodeficiency diseases.

Case report: A 3-month-old boy presented with persistent fever, hepato-splenomegaly and multiple osteolytic lesions. He was diagnosed with severe combined immunodeficiency disease and disseminated BCG infection. Despite anti-tubercular therapy combined with intravenous immunoglobulin, the evolution was fatal.

Conclusion: The case highlights the possible risk of such rare yet lethal complication of BCG vaccine. In suspected cases of primary immunodeficiency disease, inoculation of BCG should be postponed until appropriate screening tests exclude such diagnosis to prevent serious complications.

Figure 1. Abdominal computed tomography scan: Enlarged liver and spleen with multiple hypodense lesions.

Figure 2. Bone X-ray of lower limbs: multiple, round, osteolytic lesions in the femora and tibiae.

Figure 3. Skeletal scintigraphyhyperfixation in lower third of the tibias and femurs and moderate and heterogeneous hyperfixation in the right iliac wing

Figure 4. Cerebral computed tomography scan: (a) multiple lacunae in the cranial vault. (b) Intra-axial lesion in the right temporal lobe, measuring 6,5mm hypodense, with peripheral enhancement and no perilesionaledema: Tuberculoma.