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Órgano Oficial del Instituto Nacional de Pediatría

2006, Number 3

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Acta Pediatr Mex 2006; 27 (3)

Fatal disseminated disease associated to BCG vaccine in a child with severe combined immunodeficiency

Macías-Parra M, López-Corella E, Cardoso-Hernández G, Berrón-Pérez RD

Language: Spanish
References: 41
Page: 145-150
PDF size: 300.31 Kb.


ABSTRACT

Newborns in Mexico routinely receive BCG vaccination shortly after birth. Serious complications caused by the vaccine are uncommon. Disseminated infection may occur in immunodeficient patients, particularly those with defects in cell-mediated immunity. The purpose of this report is to describe one of only two autopsy cases of fatal disseminated disease seen at the National Institute of Pediatrics in Mexico City from December 1970 to December 2005. This case was a child with severe combined immunodeficiency (SCID), a seven month old boy who received BCG vaccination one day after birth; two months later he developed regional lymphadenitis with subcutaneous abscess and drainage at the injection site followed by fever and enlarged lymph nodes at other sites. At the age of five months coughing and failure to thrive were noted and a chest X ray reported an absent thymus shadow and bilateral parahilar infiltrate. The patient was unresponsive to combined antituberculous treatment and died at the age of nine months. The autopsy revealed the absence of thymus; severely hypoplastic lymphoid tissue, widespread granulomatous disease with intracellular acid fast bacilli in spleen, liver and lymph nodes and an extensive pulmonary pneumocystosis. During this period disseminated disease due to BCG was extremely uncommon with an incidence rate of 1.5 cases in / 10,000 hospital discharges and 2/10,000 autopsies. Immunization with BCG, usually an innocuous procedure, can take a serious and even fatal course in patients with an impaired immune response as in this child with primary severe combined immunodeficiency.


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