Article in Japanese

Analysis of 27 patients with BCG osteomyelitis

Takayuki HOSHINA¹⁾, Hidetoshi TAKADA¹⁾, Yuka SASAKI¹⁾, Koichi KUSUHARA^1,2), TOSHIRO Hara¹⁾

A small number of children develop osteomyelitis as a complication of the BCG vaccination. This study analyzed the clinical characteristics and the genetic backgrounds of 27 patients diagnosed as having BCG osteomyelitis. The median interval of time between BCG vaccination and the development of osteomyelitis was 11 months (5-46 months). The long bones such as the femur and humerus were commonly affected. Although many patients had a single lesion, five patients developed multiple ostepmyelitis. All patients were treated with anti-tuberculosis drugs for an average of 12 months (6-72 months) with curettage of the bone. We performed the genetic analysis on these patients for the IFNGR1, IFNGR2, IL12B, IL12RB1, STAT1 and NEMO which have been known to be associated with the development of infections caused by weakly virulent mycobacteria. Four patients had mutations in the IFNGR1 gene. All of the patients diagnosed with interferon-γ receptor 1 deficiency had multiple osteomyelitis, and three of the patients had recurrent mycobacterial infections. Among 23 patients without genetic mutations, only one patient had multiple osteomyelitis, and two had recurrent mycobacterial infections. In conclusion, BCG should be considered as one of the causative pathogens in infants having osteomyelitis, if they had received BCG vaccination. Furthermore, the analysis of IFNGR1 gene should be performed in the patients with multiple BCG osteomyelitis and recurrent mycobacterial infection.

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1) Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University
2) Department of Pediatrics, University of Occupational and Environmental Health

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Received	December 27, 2010
Accepted	April 19, 2011

23 (3)：227─232,2011