The Journal of Pediatric Infectious Diseases and lmmunology Online Journal

Abstract

The Journal of Pediatric Infectious Diseases and Immunology > Vol.33 No.2 contents > Abstract

Article in Japanese

A case of papulonecrotic tuberculid with pleocytosis after BCG vaccination

Rei INOUE1,2), Akihiko SHIRASU2), Akira ASHIDA1)

Tuberculid is a side effect of Bacille Calmette-Guerin (BCG) vaccination, and assumed to be a hypersensitive reaction to the vaccine. This paper reports a case of papulonecrotic tuberculid with pleocytosis of cerebrospinal fluid following BCG vaccination. An 8-month-old girl developed rash and fever on the 46th and 51th day, respectively, after BCG vaccination. She was admitted to hospital for persistent fever and elevated inflammatory markers. Her skin showed scattered red papule with pustules across the whole body and erythema at the BCG site. As cerebrospinal fluid examination revealed pleocytosis, antibiotics and antiviral drugs including cefotaxime (CTX), meropenem (MEPM), and acyclovir (ACV) were administered. As the fever was resolved on the second day of hospitalization, bacterial meningitis and Kawasaki disease were considered unlikely from the examination findings and course of treatment. Skin biopsy findings were histologically and bacteriologically negative for Mycobacterium tuberculosis infection. Papulonecrotic tuberculid was diagnosed secondary to the BCG vaccination, based on the course of the red papule with central pustule disappearing and leaving pigmentation. Tuberculid is considered to be a type IV allergic reaction to BCG vaccine. It was speculated that the cerebrospinal fluid pleocytosis observed in this case was caused by excessive release of inflammatory mediators, due to type IV hypersensitive reaction.


1) Department of Pediatrics, Osaka Medical College
2) Department of Pediatrics, Hirakata City Hospital

Key words tuberculid, papulonecrotic tuberculid, BCG, meningitis, type Ⅳ hypersensitivity
Received June 24, 2020
Accepted March 25, 2021

33 (2):143─148,2021

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