Case reports A rare case of Suppurative Bacille Calmette-Guerin (BCG) lymphadenitis
Keywords:
BCG, FNAC, Lymphadenitis, SuppurationAbstract
ABSTRACT
Title- A rare case of Suppurative Bacille Calmette-Guerin (BCG) lymphadenitis
Dr. Pratik P Kamlik1, Dr. Gauri Metkar2, Dr Smita Bhide3, Dr. Harsha Dangare3, Dr. Mangala Nagare4, Dr. Swapnil More5, Dr. Rajendra Zope6
Introduction:
The Bacillus Calmette Guerin (BCG) vaccine is live attenuated Mycobacterium bovis vaccine, first introduced in 1921 to prevent tuberculosis. In 1974 WHO expanded the program on Immunization so that all children should have the BCG vaccine intra-dermally.
Case History:
We are presenting a rare case of a 9 months old female child with fever, cold, and tender cervical lymphadenopathy with no past or family history of tuberculosis. Patient had acute onset cervical lymphadenopathy on the same side (ipsilateral) as that of BCG vaccination. Size of enlarged lymph node was 5 x 5 cm. On FNAC, findings were of suppurative lymphadenitis with presence of acid fast bacilli. Ipsilateral location of cervical lymphadenitis, size > 1 cm and presence of acid fast bacilli, prove it to be BCG lymphadenitis.
Discussion:
BCG lymphadenitis is a lesser-known condition with incidence of 0.5-100 per 1000 vaccinations. Most common presentation of BCG lymphadenitis is non-suppurative ipsilateral axillary lymphadenitis with onset between 2 weeks to 6 months of age. Hence this is a rare case of BCG lymphadenitis with unusual features like suppuration, cervical lymph node involvement, and presentation at 9 months of age.
Conclusion:
BCG lymphadenitis is a rare complication of BCG vaccination most commonly affecting axillary lymph nodes. Present case highlights the importance of keeping this entity in differential diagnosis of childhood lymphadenitis. FNAC with AFB (20%) staining helps in diagnosis and timely treatment of this condition eliminating the need of surgical excision and un-necessary antibiotic treatment.
Key words: BCG, FNAC, Lymphadenitis, Suppuration
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