Mycobacterial Brain Abscess Possibly Due to Bacille Calmette-Guerin in an Immunocompromised Child

Abstract

Disseminated infection with bacille Calmette-Guérin (BCG) is rare, even in immunocompromised patients who receive BCG injections as immunotherapy or immunization. When such infection occurs, it is usually in patients with decreased cellular immunity. A 6-year-old Caucasian girl who was receiving maintenance chemotherapy for acute lymphoblastic leukemia presented with symptoms of meningitis. A temporal-lobe biopsy revealed acid-fast bacilli that were identified as Mycobacterium bovis BCG. Neither the patient nor any family members had been immunized previously. Appropriate therapy resulted in a complete recovery.

Meningitis Due to Iatrogenic Bcg Infection in Two Immunocompromised Children

“…20,21 One child died, and two had favorable outcomes. In a case similar to those in this report, Coppes et al 22 described a six-year-old Canadian girl with leukemia in whom a BCG-related brain abscess and meningitis developed. No source of the BCG was identified.…”

Clinical Features and Outcome of Eleven Patients with Disseminated Bacille Calmette-Guérin (BCG) Infection

“…15 On the other hand, despite antituberculous therapy, patients with SCID invariably succumb to BCG infection unless the immune system is reconstituted. 5,17 In three of our patients, resolution of disseminated BCG infection occurred only after successful restoration of their immune function by allogeneic bone marrow transplantation from HLA-DR matched siblings. In these three patients, abscess developed at the BCG inoculation sites after the patients became immunocompetent.…”

“…Coppes et al 17 reported a case of M. bovis brain abscess and meningitis in a leukemic child who responded to treatment with isoniazid and rifampin. Similarly, other patients with BCG meningitis but no underlying immune defects were successfully treated with antituberculous therapy alone.…”

Disseminated tuberculosis with multiple intracerebral tuberculomas in a patient with anorexia nervosa

“…Some recommend early excision of the abscess because the thick, fibrotic capsule of a fully developed tuberculous abscess prohibits catheter drainage, 12 while others consider prolonged anti-TB treatment adequate. 13 For this patient, the anti-TB treatment started early, as soon as the pulmonary TB had been diagnosed. Unfortunately, no bacilli were cultured from the pus at the time of stereotactic biopsy, but this may have been a consequence of the anti-TB treatment, even though it appeared to have been ineffective.…”