Summary
Background. Tuberculosis is still relevant problem in Lithuania. Bacillus Calmette-Guerin (BCG) vaccine is used for all new borns in our country to prevent severe forms of tuberculosis. The annual BCG vaccination coverage is above 97%. Adverse events to this vaccine are very rare. The most common registered reaction is left arm pit lymphadenitis. Osteomyelitis after BCG vaccination is extremely rare complication. We present the second case of BCG osteomyelitis at Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos during the last 20 years.
Case report. 10-month-old girl presented to Children’s emergency department due to right leg trauma. She was previously healthy, received BCG vaccine on a second day of life. Imaging tests revealed congenital right hip dislocation, there fore surgical treatment was performed. Control investigation showed destruction of the right fem oral neck. Chronic osteomyelitis was suspected. Antimicrobial therapy was not effective, accordingly biopsy was performed. Acid- Fast Bacilli were identified from the biopsy material. Molecular genetic testing was positive for Mycobacterium tuberculosis complex, susceptible to rifampicin and confirmed Mycobacterium bovis BCG strain, resistant to isoniazid and pyrazinamide. The final diagnosis was BCG osteomyelitis of the proximal femoral neck, congenital right hip dislocation. Treatment with antituberculosis drugs was started.
Conclusions. BCG osteomyelitis diagnosis should be considered for the patient vaccinated with BCG and having unexplained chronic osteomyelitis symptoms. Early specific treatment is the key element for a better out come. This adverse reaction is very rare in our country and in the world. It is very important to continue vaccinate newborns in Lithuania due to unfavourable tuberculosis epidemiological situation.
