Fine‐needle aspiration cytology of Bacille <scp>Calmette‐Guerin</scp> adenitis: A perplexing distinct clinical entity

Jain, Aleena; Gupta, Shruti; Gupta, Parikshaa; Rohilla, Manish; Gupta, Nalini; Srinivasan, Radhika; Rajwanshi, Arvind; Dey, Pranab

doi:10.1002/dc.24613

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…Intradermal BCG vaccine gives rise to classic primary complex that simulates tuberculous infection and consists of a cutaneous nodule at the site of injection along with subclinical involvement of the regional lymph nodes. 7 The incidence of complications varies from 0.1% to 17%, with lymphadenitis being the most common, which is self-limiting and requires no treatment. Causative factors attributed include early age of the child, immunodeficiency, subcutaneous injection rather than intradermal, higher dose, or strain-related factors.…”

Section: Discussionmentioning

confidence: 99%

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Bacillus Calmette-Guerin lymphadenitis in children: an underdiagnosed entity

Singh,

Gupta

2024

Int J Community Med Public Health

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Background: Bacillus Calmette-Guerin (BCG) lymphadenitis is a common complication after BCG vaccination. Fine needle aspiration cytology (FNAC) is a feasible and cost-effective procedure for the diagnosis and management of this entity. Awareness of this entity in cytology is important to avoid misdiagnosis, as the cytomorphologic features are very similar to tuberculosis. The present study described the clinical presentation and detailed cytomorphologic features in patients with BCG lymphadenitis. Methods: This was a retrospective study from 2018 to 2022 involving a total of 27 patients who presented with isolated left axillary or cervical lymphadenopathy. Results: Age at presentation ranged from 1 to 24 months. The male- to-female ratio was 2.75:1. Majority of the children had enlargement of the left axillary lymph nodes followed by cervical nodes. Cytomorphology showed the presence of dense acute and chronic inflammatory cells, epithelioid cell granulomas, multinucleated giant cells, histiocytic aggregates, reactive lymphoid cells, lymphohistiocytic clusters and calcification. Necrotic background was present in 25 (92.6%) cases. Ziehl-Neelsen staining for acid-fast bacilli was positive in 17 (62.9%) cases. Conclusions: A high index of clinical suspicion for BCG lymphadenitis should be kept in mind for children who are recently vaccinated. Diagnosis of this entity is based primarily on clinical grounds. However, cytology and microbiological examination are encountered as part of clinical work up of lymph node swelling. FNAC in conjunction with clinical presentation is useful for diagnosis of BCG lymphadenitis and avoid an unwarranted tubercular treatment.

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Section: Discussionmentioning

confidence: 99%

“…Causative factors attributed include early age of the child, immunodeficiency, subcutaneous injection rather than intradermal, higher dose, or strain-related factors. 7,8 Table 3: Criteria for BCG lymphadenitis.…”

Section: Discussionmentioning

confidence: 99%

Bacillus Calmette-Guerin lymphadenitis in children: an underdiagnosed entity

Singh,

Gupta

2024

Int J Community Med Public Health

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“…Needle aspiration has been found to be effective in treating small swellings or suppuration, but surgical removal of enlarged lymph nodes has been seen as effective in difficult cases [17]. A high index of clinical suspicion is essential for proper and timely diagnosis in recently vaccinated children [18].…”

Section: Discussionmentioning

confidence: 99%

Bacillus Calmette-Guérin Adenitis: An Intriguing Series of Four Cases

Mandal,

Nayak,

Mangal

2024

NJLM

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Bacille Calmette-Guérin (BCG) vaccine is part of the immunisation schedule in India. It is a live-attenuated vaccine with very few adverse reactions, one of which is BCG adenitis. The intriguing fact is that there has been a sudden upsurge in the number of BCG adenitis cases (two males and two female children), with four reported cases within three months (March 2023-June 2023). There were two male and two female children, aged between 2-8 months. All of them presented with left axillary swelling, and all but one had low grade fever only in the initial days. They all had a healed BCG vaccination scar on their left arm. Fine Needle Aspiration Cytology (FNAC) showed multiple epithelioid granulomas and, in some cases, frank caseation necrosis with the demonstration of tubercle bacilli using either Ziehl-Neelsen (Z-N) stain or Cartridge-based Nucleic Acid Amplification Test (CBNAAT). These cases mostly benefited from pus aspiration from the swelling site, with no definite role for oral antibiotics. Proper training of nursing or paramedical staff regarding vaccination technique and dosage, proper maternal and child healthcare, early detection of these cases with a high index of suspicion, as well as adequate knowledge of the treating doctors and parents/caregivers, may help in prompt management of these cases in future occurrences.

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“…Based on the literature [4,10,12,14,18,19,[27][28][29][30] and our preliminary experience, a flow chart (Fig. 3) was introduced for the management of BCG vaccine-induced regional lymphadenitis.…”

Section: Discussionmentioning

confidence: 99%

The role of surgical management of BCG vaccine-induced regional suppurative lymphadenitis in children: a 7 years' experience from one medical center

et al. 2021

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Background The management strategy of Bacille Calmette-Guérin (BCG) vaccine-induced regional suppurative lymphadenitis in children is still controversial and more clinical studies are needed. We therefore present a surgical case series to explore the role of surgical management for this dilemma. Methods From January 2013 to June 2020, data from 65 patients diagnosed with BCG vaccine-induced regional suppurative lymphadenitis were retrospectively reviewed. Clinical characteristics, ultrasonographic findings, surgical procedures, perioperative management, and outcome were analyzed. The association between postoperative seroma and symptom duration, skin involvement, and postoperative hospital stay were compared using Yates's corrected Chi-square test and Student's t-test for statistical analysis. The follow-up period ranged from three to six months. Results Of the 65 cases, the median age at presentation was 3.4 months. All patients were full-term with normal range of birth weight and received a BCG vaccination in the first 24 h of life. All patients underwent surgical excision of the abscess with the involved lymph node(s). Postoperative seroma formation was found in 20 patients and fine needle aspiration was needed. There was no significant association between postoperative seroma formation with symptom duration, skin involvement, and postoperative hospital stay. No oral anti-tubercular agents were given postoperatively. The mean length of postoperative hospital stay was 6.02 ± 1.62 days. Sixty-four cases (98.46%) received only one procedure and recovered. One patient required a second procedure due to postoperative sinus. Conclusions The present study showed that surgical excision of the abscess with involved lymph node(s) is one of the choices for BCG vaccine-induced suppurative lymphadenitis, but special attention should be paid to controlling the surgical indications. Intraoperative meticulous manipulation and postoperative care are crucial to achieve a good outcome.

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Fine‐needle aspiration cytology of Bacille Calmette‐Guerin adenitis: A perplexing distinct clinical entity

Cited by 8 publications

References 8 publications

Bacillus Calmette-Guerin lymphadenitis in children: an underdiagnosed entity

Bacillus Calmette-Guerin lymphadenitis in children: an underdiagnosed entity

Bacillus Calmette-Guérin Adenitis: An Intriguing Series of Four Cases

The role of surgical management of BCG vaccine-induced regional suppurative lymphadenitis in children: a 7 years' experience from one medical center

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