Update on cutaneous complications of Bacille Calmette-Guérin immunization

Abstract

Bacille Calmette-Gué rin (BCG) is an attenuated form of Mycobacterium bovis that is used to offer protection against tuberculosis . Usually, 3-4 weeks after vaccination, an inflamed infiltrated papule appears, and then an ulcer develops, which heals by the 13th week. However, sometimes complications occur following BCG vaccination or immunotherapy, including cutaneous complications, which have been discussed in this review. Erythema, soreness, ulceration, blistering, keloid, BCG lymphadenitis, and inoculation site abscess occur frequently. Rare complications include complications directly related to vaccine components such as cold abscess of the chest wall, cutaneous granulomas (early and delayed), lupus vulgaris, sarcoidosis, and reactivation granulomatous skin lesions in patients with Kawasaki disease. Complications related to triggered immune response of the patient rather than to the vaccine itself include papular tuberculids, lichen scrofulosorum-like eruption, fixed drug eruption, and granuloma annulare. M. bovis infection of the penis, scrotal abscesses, Reiter's syndrome, and cryoglobulinemia vasculitis were reported during BCG intravesical immunotherapy. Intralesional BCG immunotherapy can induce lupus vulgaris, disseminated BCG, and erythema multiforme. In conclusion, BCG vaccination is to be promoted; however, the use of a less virulent vaccine and proper vaccination techniques to minimize BCG complications is advised. Proper selection of those receiving the vaccines should be considered.

Disseminated Erythematous Papules and Pustules: A Quiz

“…BCG is a live, attenuated strain of Mycobacterium bovis developed by Calmette and Guérin for vaccination against tuberculosis and other mycobacterial infections. In Japan, all infants have been obligated to receive BCG vaccine since 2005, and various adverse effects, such as BCG lymphadenitis and tuberculids, have been observed (1,2).…”