1. Introduction
The Bacillus Calmette-Guerin (BCG) vaccination is globally used for the prevention of tuberculosis throughout the world. In Lithuania 97.7% of new-borns were given BCG Danish 1331 strain vaccine in 2014 1. Although this vaccine prevents severe forms of tuberculosis (TB) and has a high safety profile, a variety of complications can sometimes develop. Mostly the complications are encountered in local skin complications2 and regional suppurative lymphadenitis; however, it can also cause disseminated disease, a fatal prognosis in infants with a particular immune deficiency. Bone osteomyelitis is a relatively rare complication of the BCG vaccination and often is involving long bone epiphysis. There are only a few reports about sternal …show more content…
There was not substantiation for neoplastic processes, therefore an oncological diagnosis wasn’t performed. Normal immunologic tests (normal values of immunoglobulin A, M, G, Ag, normal phagocytic activity of neutrophils and nitro-blue tetrazolium test, a sufficient level of circulating immune complexes and negative immunofluorescence assay of Human Immunodeficiency Virus (HIV) ruled out a possible diagnosis of primary or secondary immunodeficiency, ruling out the possibility of haematological disease. Changes in the chest computer tomography (CT) scan revealed a round mass with central hypodense areas both with and without contrast.
Additional data was collected from the patient’s parents claiming that the boy’s grandmother was suspected of suffering from tuberculosis.
A consequent sternal biopsy was performed and M. bovis BCG was identified by a positive growth culture in liquid MGIT 960 system using the GenoType method. These findings confirmed the diagnosis of M. tuberculosis BCG osteomyelitis. Treatment with rifampicin, isoniazid, ethambutol and streptomycin was started. Control CT scans were performed every 3 months. Full recovery was achieved after six months of antibacterial …show more content…
Sometimes, tubercle bacilli might be transported to the sternum via the blood following the development of the primary pulmonary lesion. Osteomyelitis of the sternum usually appears as a complication of chest trauma also sternotomy, mediastinitis, or a subclavian intravenous line insertion. In our case it is not clear which factor influenced the BCG sternal osteomyelitis. Our patient had a mild fall at the age of three months with no serious injuries; also, at the age of four months he suffered from pneumonia. In addition to the treatment with oral cefuroxime he received daily vibrant massages, which might have influenced the M. bovis transportation to the sternum via the blood. Our patient completely recovered after six months of complex TBC specific antibacterial therapy. The follow up during eight years confirmed that stable recovery has been
The Bacillus Calmette-Guerin (BCG) vaccination is globally used for the prevention of tuberculosis throughout the world. In Lithuania 97.7% of new-borns were given BCG Danish 1331 strain vaccine in 2014 1. Although this vaccine prevents severe forms of tuberculosis (TB) and has a high safety profile, a variety of complications can sometimes develop. Mostly the complications are encountered in local skin complications2 and regional suppurative lymphadenitis; however, it can also cause disseminated disease, a fatal prognosis in infants with a particular immune deficiency. Bone osteomyelitis is a relatively rare complication of the BCG vaccination and often is involving long bone epiphysis. There are only a few reports about sternal …show more content…
There was not substantiation for neoplastic processes, therefore an oncological diagnosis wasn’t performed. Normal immunologic tests (normal values of immunoglobulin A, M, G, Ag, normal phagocytic activity of neutrophils and nitro-blue tetrazolium test, a sufficient level of circulating immune complexes and negative immunofluorescence assay of Human Immunodeficiency Virus (HIV) ruled out a possible diagnosis of primary or secondary immunodeficiency, ruling out the possibility of haematological disease. Changes in the chest computer tomography (CT) scan revealed a round mass with central hypodense areas both with and without contrast.
Additional data was collected from the patient’s parents claiming that the boy’s grandmother was suspected of suffering from tuberculosis.
A consequent sternal biopsy was performed and M. bovis BCG was identified by a positive growth culture in liquid MGIT 960 system using the GenoType method. These findings confirmed the diagnosis of M. tuberculosis BCG osteomyelitis. Treatment with rifampicin, isoniazid, ethambutol and streptomycin was started. Control CT scans were performed every 3 months. Full recovery was achieved after six months of antibacterial …show more content…
Sometimes, tubercle bacilli might be transported to the sternum via the blood following the development of the primary pulmonary lesion. Osteomyelitis of the sternum usually appears as a complication of chest trauma also sternotomy, mediastinitis, or a subclavian intravenous line insertion. In our case it is not clear which factor influenced the BCG sternal osteomyelitis. Our patient had a mild fall at the age of three months with no serious injuries; also, at the age of four months he suffered from pneumonia. In addition to the treatment with oral cefuroxime he received daily vibrant massages, which might have influenced the M. bovis transportation to the sternum via the blood. Our patient completely recovered after six months of complex TBC specific antibacterial therapy. The follow up during eight years confirmed that stable recovery has been