Archivesof Disease in Childhood, 1984,59, 157-161.pdf

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Archivesof Disease in Childhood, 1984,59, 157-161.pdf

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Archivesof Disease in Childhood, 1984,59, 157-161

Archives ofDisease in Childhood, 1984, 59, 157-161 BCG vaccination as a cause of osteomyelitis and subcutaneous abscess H PELTOLA, I SALMI, V VAHVANEN, AND J AHLQVIST Childrens Hospital, University of Helsinki; Departments ofPaediatrics, Surgery and Pathology, Aurora Hospital; and Orthopaedic Hospital of The Invalid Foundation, Helsinki, Finland SUMMARY Ten patients with osteomyelitis and three with a subcutaneous abscess, all caused by BCG vaccination, are described. All patients were less than 3 years old and had as newborns been vaccinated intracutaneously in the left gluteal or hip area. Pain, limping, or a slightly tender subcutaneous induration were the primary symptoms. The sites of predilection of osteomyelitis were the metaphysis or epiphysis of the femur, these being affected in five out of 10 cases. All three subcutaneous abscesses were in the thoracic region. Prolonged (up to 30 months) combined tuberculostatic medication, in addition to appropriate surgical procedures, resulted in healing, but two cases of arthritis and two of secondary abscesses developed. In addition, sequestrectomy and two late operations, for coxa valga and hip subluxation, were deemed to be necessary. Radiographs showed femoral overgrowth of up to 1 cm in two symptomless patients three to seven years after the first discharge. We conclude that the benefits of BCG vaccination should be weighed against the risk of complications, especially in countries with a low incidence of tuberculosis. Osteomyelitis, also called osteitis, caused by neonatal BCG vaccination is a well known entity among bone infections in Scandinavia and elsewhere in Europe,`-3 where for decades this immunisation has been practised routinely. Despite controversy about the efficacy of BCG vaccination,4 there is general consensus, for example, in Finland, that the disap- pearance of meningeal, miliary, and other serious forms of childhood tuberculosis can be attributed chiefly to neonatal immunisation. On the other h