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A6959 - BCGitis in a Child with Primary Immunodeficiency, Chronic Granulomatous Disease: A Case Report
Author Block: C. L. Grizales1, V. Rojas2, J. M. Sanchez3, L. Fernandez4, L. F. Sua Villegas5, C. S. Leib6; 1Pediatric Pulmonology, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 2Pediatric Resident, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 3Medical Student, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 4Interventional Pulmonology, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 5Departament of Pathology and Laboratory Medicine, Fundacion Valle del Lili, Universidad Icesi, Calli, Colombia, 6Medical Research, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia.
INTRODUCTION The Bacille Calmette-Guérin (BCG) vaccine is prepared using an attenuated strain of Mycobacterium bovis. Its purpose is to prevent the severe forms of tuberculosis. Adverse reactions to BCG vaccination, either local or systemic, are very rare. Disseminated infections have been described in patients with primary or secondary immunodeficiencies. Chronic granulomatous disease (CGD) is a primary immunodeficiency in which phagocytosis is compromised. It is characterized by an increased predisposition to recurrent and severe bacterial and fungal infections. We report a case of a disseminated M.bovis infection in a patient with post-vaccination diagnosis of CGD. CASE REPORT A 3 month-old infant, coming from a southern region of Colombia, without relevant perinatal history and complete vaccination for the age, presents to our service with 1 month of fever and a mass in the left side of the neck. Biopsy confirmed a tuberculous lymphadenitis in a lymph node. Chest CT-scan is notable for enlarged axillary and left retropectoral lymph nodes up to 8 mm in size and multiple centrilobular nodes. Cervical node biopsy reports a positive culture for acid-fast bacilli. A diagnosis of mycobacteriosis secondary to M.bovis vaccination is determined and a triconjugate regimen is initiated. The patient is also formally tested for immunodeficiencies with a positive dihydrorhodamine-1,2,3 reaction consistent with CGD; then a successful allogeneic bone marrow transplant was performed and the patient evolved satisfactorily. DISCUSSION Adverse reactions to the BCG vaccine are very infrequent worldwide, with a rate of 0.1 to 2 cases per million vaccinations. The high percentage of patients with disseminated M.bovis infection and severe immunosuppression is an indication to test for primary and secondary immunodeficiencies in all patients with adverse reactions to the BCG vaccine. In this case, an infant with a previous history of BCG vaccination had an adverse reaction to the vaccine and therefore underwent an immunological evaluation, with a positive result for CGD. Posteriorly the patient had an adequate control of the condition after a successful bone-marrow transplant.