Mycobacterium W. - An unusual side effect

Abstract

Objective To present an interesting case of unusual side effect of Mycobacterium W. in an adult COVID 19 positive male and discuss its assessment and management. Methods . Design Case Report. Setting Tertiary care hospital. Patient One. Results 70 years male was admitted with complaints of fever, persistent dry cough since 10-12 days and progressive breathlessness since 3-4 days. Patient was found COVID-19 RTPCR positive and is known case of Type-II Diabetes with CAD (Post PTCA). Patient was managed conservatively with Oxygen support, I/V antibiotics, I/V Steroids, oral Favipiravir and other supportive treatment. Patient was also given injection Mycobacterium W. in dose of 0.3 ml per day intradermally at 3 different sites (both deltoids) consecutively for three days. 7-8 days after administration, patient developed bright red pustules which later got converted into small punched out ulcerations on all nine local sites of administration, which were managed conservatively with oral analgesics and local steroids for 8 to 10 days which healed without any scar formation. Conclusion Injection Mycobacterium W. is used in COVID 19 patients as an immunomodulator agent and has been proved to be safe in most of the cases but we encountered this unusual side effect of bright red pustules formation at all nine local sites of injection in our case most likely because of being administered subcutaneously instead of intradermally, making this an interesting case which is being reported to scientific fraternity.

Injection site reactions associated with the use of Mycobacterium w in COVID‐19 patients

“…also reported a similar case where the patient developed injection site ulcerations at all nine injection sites. 6 …”

“…Chawla et al also reported a similar case where the patient developed injection site ulcerations at all nine injection sites. 6 This report aims to highlight the adverse effects that can arise with the use of this exploratory therapy in COVID-19 patients. It is important to ask about the history of intradermal injections if one encounters such lesions and recognize that no specific treatment is required as these lesions subside on their own.…”

Non-infective granulomatous dermatitis following Mycobacterium w injections

“…A diagnosis of non-infective granulomatous dermatitis was given based on the histopathology features and side effects mentioned in the literature. 2 She was started on 20 mg prednisolone and the lesions subsided within one month leaving behind post-inflammatory scarring [Figure 5]. She is on regular follow up with no recurrence.…”

“…This was in accordance with the guidelines laid down by the Global Research Collaboration for Infectious Disease Preparedness and the World Health Organization, which suggested that adjuvant therapy is one of the methods to save patients infected with severe COVID-19 infection. 2 Mechanism of action of Mycobacterium w vaccine as studied in leprosy was via toll-like receptors, thus enhancing the host T cell responses. It is known to be safe and well-tolerated in gram-negative sepsis and the recent report also suggests the same for severe COVID-19 infection.…”

Mycobacterium Indicus Pranii (MIP) Vaccine: Pharmacology, Indication, Dosing Schedules, Administration, and Side Effects in Clinical Practice

“…All the lesions were managed conservatively with analgesics with or without topical steroids. [ 38 ]…”