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SMJ // Article

Case Report

Subcutaneous Abscess in the Lower Leg Caused by BCG-Related Osteomyelitis

Authors: Cheng-Kuang Chang, MD, Wei-Chou Chang, MD, Herng-Sheng Lee, MD, Chia-Chun Wu, MD, Guo-Shu Huang, MD

Abstract

We report an unusual case of tibial osteomyelitis resulting from Bacille Calmette-Guerin vaccination and causing subsequent cortical destruction and a subcutaneous abscess. A 10-month-old infant initially presented with a tender palpable mass below the left knee. Radiographs showed an osteolytic lesion in the proximal metaphysis of the tibia. Magnetic resonance imaging (MRI) showed a pedicle-based juxtacortical abscess communicating with the cortex and marrow space of the proximal tibia. The mass was excised surgically and tuberculous osteomyelitis was confirmed by polymerase chain reaction. In the present case, MRI demonstrated the mechanism of subcutaneous abscess formation caused by BCG-related osteomyelitis.


Key Points


* Vaccination against tuberculosis (TB) by means of intracutaneous inoculation of Bacille Calmette-Guerin (BCG) is widely used and generally well tolerated.


* Tuberculous osteomyelitis caused by BCG vaccination has rarely occurred. Lack of awareness of this entity may result in delayed diagnosis, giving tuberculous infection a chance to break through the thinner metaphyseal cortex to form a subcutaneous abscess.


* In children with a painful palpable mass, subcutaneous abscess originating from BCG-related osteomyelitis should be include in the differential diagnosis.

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