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Article in Japanese

A case of papulonecrotic tuberculid as a side effect of Bacille Calmette-Guérin (BCG) vaccine administration

Yasufumi ENDO

Papulonecrotic tuberculid is vasculitis caused by an allergic reaction in tuberculosis patients. Recent reports describe the side effect of Bacille Calmette-Guérin (BCG) vaccine administration as formation of dark red papules that become crusty and ulcerated, primarily on the legs of young girls. A 6-month-old female infant was brought to our hospital mainly presenting fever, which was alleviated on day 4 of treatment as an outpatient. During this period, red spots of 2-3 mm in diameter developed all over her body, and she was diagnosed with exanthema subitum. However, the red spots did not disappear and continued to spread over her body. Therefore she was re-examined 13 days after the fever had subsided. Examination revealed many papules and red spots with pustules and blisters approximately 2-3 mm in diameter on the face, trunk, and legs. There was no related enanthema. Medical history revealed that the subject had received a BCG vaccination 45 days before developing the fever. Consequently, dermatology clinic was consulted and skin biopsy requested.
Pathological findings showed clinical features including multiple necrotic papules without acantholysis, but with leukocytoclastic vasculitis; thus, papulonecrotic tuberculid with suppurative granulomatous inflammation and fibrosis was diagnosed. The rash cleared after the administration of moderate doses of topical corticosteroids and anti-allergic agents. This case is reported with additional pathological study and a literature review.

Department of Pediatrics, Ichinoseki Hospital (present address: Department of Pediatrics Tendo City Hospital)

Key words
Received October 15, 2013
Accepted January 6, 2014

26 (1):11─14,2014