Abstract
IntroductionThigh swelling in an infant can be a symptom of a simple benign condition or a life-threatening condition. We observed a cluster of thigh swelling episodes in infants in which the cause was Bacillus Calmette-Guérin-related cold thigh abscess. We report this unusual case series to raise awareness about this diagnosis.Case presentationsWe performed a retrospective review of five infants (four boys and one girl) who presented with Bacillus Calmette-Guérin-related left thigh abscess. The swelling was noticed by the parents at a mean period of three months prior to presentation. The ages at presentation were five, five, eight and nine months for the boys, and six months for the girl. All of the patients were healthy Saudi infants, and received the Bacillus Calmette-Guérin vaccine at birth. Clinically, all of the patients were well and did not demonstrate signs of systemic infection. All patients underwent needle aspiration, with subsequent incision and drainage in four of the five cases. The cultures obtained from the abscess fluids were the key to establishing the diagnosis. Only three patients (60%) received antituberculosis drugs. Wound healing lasted for a mean period of approximately seven months. Two-year follow-up was unremarkable for all of our patients.ConclusionsTechnical errors continue to be significant in the development of vaccine-related complications. Bacillus Calmette-Guérin-related cold thigh abscess is an extremely rare entity.
Highlights
Thigh swelling in an infant can be a symptom of a simple benign condition or a life-threatening condition
Case 1 A six-month-old healthy Saudi girl presented with left thigh swelling that was noticed by her parents three months prior to presentation
Magnetic resonance imaging (MRI) of her left thigh did not provide a clear answer but revealed signs of hematoma and indicated that needle aspiration be used for a final diagnosis
Summary
Bacillus Calmette-Guérin (BCG) vaccine is considered one of the safest vaccines available [1,2]. At the site of the needle aspiration, our patient developed a sinus that healed within six months, leaving a small scar. A physical examination revealed a soft, fluctuant, nontender left thigh lesion with no overlying skin changes. Laboratory tests revealed a WBC count of 16.8 × 109/L and an ESR of 13 mm/h An ultrasound of his left thigh indicated an abscess. A physical examination revealed a fluctuant, nontender left thigh lesion with overlying skin erythema. At the site of the I&D, our patient developed a sinus that healed within eight months, leaving a small scar.
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