The bacillus Calmette-Guérin (BCG) vaccine is a safe live vaccine mainly administered to infants to prevent tuberculosis; complications rarely occur after administration of the BCG vaccine. Herein, we report the case of an infant who developed a rare complication of a tuberculous abscess in the chest wall and osteomyelitis in the ribs after administration of the BCG vaccine at 1 month of age. An 11-month-old male infant was admitted to the hospital due to a palpable mass in the right anterolateral chest area detected about a month before hospitalization, with no tenderness, erythema, or lymphadenopathy. After thoracic computed tomography and ultrasonography, the cause of the abscess was suspected to be mycobacterial infection and the abscess was removed under general anesthesia. Chronic granulomatous inflammation with caseous necrosis was detected through a biopsy, and polymerase chain reaction was performed and
The bacillus Calmette-Guérin (BCG) vaccine is a safe live vaccine derived from an attenuated strain of
An 11-month-old male infant developed a palpable mass approximately 6×3 cm in size on the right anterolateral chest wall on the right 5th to 8th ribs a month before presentation. The infant had a full-term normal delivery and weighed 3.1 kg at birth. The medical history of the infant did not include signs of immunodeficiency, since blood tests performed at birth were normal and scheduled vaccinations were administered without significant complications. The patient had a history of BCG vaccination on the left upper arm 10 months earlier; at the inoculation site there were no signs of infection except for the presence of linear scars with mild redness. The patient had no history of chest injury, no contact with tuberculosis patients, and no history of medications.
The lesion was not a sign of infection; there was no tenderness, erythema, or warmth. Moreover, lymphadenopathy was not observed during the physical examination (
There was no active parenchymal lesion on either of the lungs with definite evidence of active tuberculosis pneumonia. Diagnostic ultrasonography and fine-needle aspiration were performed, indicating no change in the size of the abscess; hence, the presence of a soft tissue abscess rather than a hematoma was confirmed.
Surgery was performed under general anesthesia for reconfirmation and removal of the mass. We found the abscess in the subcutaneous layer. Pus was observed when the dissection took place. Irrigation was performed to remove the pus and devitalized tissues were removed. We then conducted debridement and curettage on the bone erosion area without resecting the bone. A thoracic surgeon checked for the presence of invasions in the thoracic cage and found none. The tissue obtained during surgery was submitted for histopathological examination, where chronic granulomatous inflammation with caseous necrosis was observed. Polymerase chain reaction was conducted for the detection of
Based on the test results and the patient’s medical history, we diagnosed the patient as having tuberculous abscess and osteomyelitis caused by BCG vaccine. After treatment with isoniazid (10 mg/kg) and rifampicin (10 mg/kg) for 6 months, the symptoms improved and no complications were observed (
The BCG vaccine is a live vaccine used worldwide to prevent tuberculosis. In Korea, 96% to 97% of infants receive BCG vaccination at 4 weeks after birth [
The treatment of complications from administering the BCG vaccine in the chest wall has been previously discussed [
In the present study, mycobacterial cultures from samples provided by aspiration during ultrasonography and from surgical evacuation of the abscess were negative. However, polymerase chain reaction was performed and
The regimen for anti-tuberculosis drug treatment may differ depending on the country of treatment or the therapist [
Several case studies, though with symptoms different from those of the infant in our study, reported the presence of abscess after administration of the BCG vaccine in patients aged 8 to 17 months. Even if the small number of cases prevents robust statistical analysis, it should be acknowledged that complications can occur several months after administration of the BCG vaccine. The possibility of “BCG-oma” should be considered when diagnosing lesions on children aged 12 months old [
Masses that develop in the chest wall of children can be due to an underlying disease, congenital abnormality, trauma, neoplasm, or infection [
This work was supported by Chosun University Research Fund. Otherwise, no potential conflicts of interest relevant to this article are reported.
Preoperative view of protruding mass in the right chest wall.
Preoperative radiological images. (A) Preoperative computed tomography scans. Approximately 7×2.6 cm multiseptated mass (arrow) on the anterolateral chest. (B) Approximately 1.5 cm osteolytic bone lesion (arrow) in the right 5th rib.
Biopsy image of the abscess. Chronic granulomatous inflammation with caseous necrosis (arrow) (H&E, ×100).
Computed tomography images of the patient 9 months after surgery. (A) Near complete postoperative improvement in the right anterior chest wall. (B) The osteolytic bone lesion is improved.