Exaggerated BCG lymphadenitis: clinical profile.

Abstract

Clinical profile of 104 children with exaggerated BCG lymphadenitis was studied. 90 children were below one year of age. 64 were boys and 40 were girls. 95 had received BCG vaccination before the age of one year and only 18 had been vaccinated before three months. Papular reaction and scab formation at the site of vaccination were noted five and eight weeks respectively following vaccination. Noticeable enlargement of axillary lymphnodes was observed nine weeks after vaccination. Onset of lymphadenopathy was sudden in 80 and insidious in 24. 34 cases had variable degree of liquefaction at the time of presentation with its highest incidence in age group of 3–6 months. While 20 per cent of the cases had associated symptoms like pyrexia, anorexia, irritability, pain, subcutaneous nodules, induration and oedema of surrounding tissues, 80 per cent were asymptomatic. In cases with lymphadenopathy of shorter duration (2.4 weeks) average size of swelling was 2.7 cm and in those with longer duration (9.3 weeks) it was 4.0 cm. Liquefaction was recorded in 11.4 per cent of the former and 64.7 per cent of the latter group. After initiation of therapy with isoniazid no further increase in the size of swelling or frequency of liquefaction was observed thereby suggesting that cases with longer duration reflected the course of exaggerated BCG lymphadenitis if left untreated for the first two months. Nearly half of the cases were followed for six to eight months. Local reaction at the site of vaccination did not exceed 1.0 cm in any of the cases. It was associated with recurrent oozing in 70 per cent. Complete healing of the local reaction had occurred in all by 12 weeks. Complete regression of lymphadenopathy was recorded over an average period of five months. It was earlier in cases with shorter duration (3.8 months) than in those with longer duration (6.0 months). Children with liquefaction of the glands were slower to heal (6.3 months) than those without liquefaction (4.4 months).