Abstract
BackgroundReactivation of the Bacillus Calmette-Guérin (BCG), manifesting as erythema, induration, ulceration or crust formation at a previous BCG inoculation site, is a common and highly specific feature of Kawasaki disease (KD). We report the unusual finding of BCG reactivation in an infant with laboratory-confirmed measles.Case presentationA previously healthy 7-month old infant presented initially with fever, cough and coryza, and subsequently developed Koplik’s spots followed by a typical morbilliform skin rash. There was significant contact history with a household relative who had recently been diagnosed with measles. On examination, a 2.5 cm area of erythema and induration was seen at the previous BCG inoculation site, in addition to the widespread maculopapular rash. No other clinical features of KD were present. Measles virus was isolated from the throat swab and measles antibodies (IgM) were present in the serum. The patient recovered completely with oral vitamin A and supportive therapy, and had normal echocardiography examination on follow up.ConclusionsThis case report highlights the rare finding of BCG reactivation in a child with confirmed measles infection, and suggests that this clinical manifestation may occasionally occur in children with infections or conditions other than KD.
Highlights
Reactivation of the Bacillus Calmette-Guérin (BCG), manifesting as erythema, induration, ulceration or crust formation at a previous BCG inoculation site, is a common and highly specific feature of Kawasaki disease (KD)
This case report highlights the rare finding of BCG reactivation in a child with confirmed measles infection, and suggests that this clinical manifestation may occasionally occur in children with infections or conditions other than KD
Following intradermal inoculation of the attenuated Mycobacterium bovis BCG strain at the deltoid region of the left arm, a small papule usually appears after 2 weeks, gradually enlarges and typically ulcerates within 2–4 months, and slowly heals over the few months to form the BCG scar [4]
Summary
Bacillus Calmette-Guérin (BCG) vaccine is used to prevent tuberculous meningitis, miliary tuberculosis and possibly other forms of tuberculosis, including pulmonary disease, in children [1, 2]. We present a case report of a 7-month old infant with laboratory-confirmed measles who presented with erythema and induration at the BCG inoculation site. Muthuvelu et al BMC Pediatrics (2019) 19:251 had received BCG vaccination (BCG-Japan, Tokyo 172 strain) at birth, at the same hospital According to his mother, a papule had developed at the inoculation site which had healed completely to form a scar in the months prior to the admission. Physical examination of the child revealed Koplik’s spots and he was admitted to the medical centre Later that day, he developed a typical morbilliform rash which began behind the ears and neck, and spread to his face and trunk. Measles-specific antibodies (IgM) in the serum were detected by an indirect enzyme linked immuno-sorbent assay (ELISA) using a commercially available test kit (Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany)
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