Disseminated Bacillus Calmette‐Guerin Infection in an HIV‐Infected Child: A Case with Cutaneous Lesions

Abstract

A boy born to a mother with unknown HIV infection was immunized with BCG in his first month of life. Seven months later axillary adenopathy developed. At the age of 10 months, 2 months after HIV infection had been diagnosed, papular skin lesions appeared all over his body. Mycobacterium bovis, BCG strain, was cultured from a lymph node and blood. Ziehl-Neelsen stain of a skin biopsy specimen showed histiocytes loaded with numerous acid-fast bacilli. The patient died 10 days later, before the infection was confirmed. This is the first reported case of disseminated BCG infection in an HIV-infected child presenting with cutaneous lesions.

Induction of an AIDS Virus-Related Tuberculosis-Like Disease in Macaques: a Model of Simian Immunodeficiency Virus- Mycobacterium Coinfection

“…The potential utility of this strategy is supported by clinical case reports that have documented M. bovis disease in HIV type 1 (HIV-1)-infected humans who have been vaccinated with M. bovis BCG (2,5,27,28,34). Moreover, M. bovis infection in humans can induce a zoonotic tuberculosis that is indistinguishable from that caused by M. tuberculosis in terms of pathogenesis, lesions, and clinical findings (3,8,24,30).…”

“…Nevertheless, the SIV mac -BCG coinfection models may be relevant to the tuberculosis-like diseases in AIDS from an immunological standpoint, although coinfection with virulent M. tuberculosis strains is more likely to induce a disease process that resembles HIV-related tuberculosis. In fact, development of M. bovis BCG-induced tuberculosis-like disease or BCG reactivation has been reported in HIV-infected humans (2,5,27,28,34). Zoonotic tuberculosis caused by M. bovis can also be identified in HIV-infected persons (17,18,29).…”

Disseminated BCG disease with unusual manifestations

“…In literature, these lesions are variably described as multiple papular nodules, subcutaneous nodules and disseminated skin lesions. Such papular lesions were also described in children with disseminated BCG infected with HIV [7]. Our patient had a generalized maculopapular skin rash over the body mimicking LCH.…”

Disseminated BCG Infection in Severe Combined Immunodeficiency

“…Disseminated BCG infection is frequently associated with a deficiency in cell-mediated immunity, such as HIV infection, SCID and chronic granulomatous disease ( 1,(3)(4)(5). BCG vaccination is contraindicated with infants with immunodeficiency, but these individuals are usually inoculated with BCG prior to diagnosis of immunodeficiency, as BCG is administered during the newborn period.…”

“…These include multiple papulo-nodular or subcutaneous nodular lesions (1,(3)(4)(5)(6)(7)(8). Histopathological features are characterized by diffuse histiocytic infiltrates without caseation necrosis or apparent epithelioid granuloma formation (1,5,6). Thus, there could be a risk that these patients are misdiagnosed as having histiocytic neoplasms (1,5,6), such as Langerhans' histiocytosis and non-Langerhans' cell histiocytosis.…”