Abstract

BCG (Bacillus Calmette Guerin) being a live attenuated vaccine may cause disseminated disease (BCGiosis) in patients with impaired immunity. Patients with severe combined immunodeficiency (SCID) having defect in both cellular and humoral immunity are predisposed to a host of live vaccine related complications, especially BCG.

We report a 6 month-old baby boy with fever for 5 months, generalized rash for 3 months, cough and cold for 1 month, poor feeding and weight loss over last 1 month. He had an uneventful perinatal period and received BCG at birth. Examination revealed mild pallor, generalized erythematous papular rash with central crusting and splenohepatomegaly. Skin biopsy and culture confirmed BCG infection while computed tomography of abdomen and skeletal survey showed disseminated involvement. Immunological investigations were suggestive of an underlying SCID. The infant showed improvement with antitubercular therapy combined with intravenous immunoglobulin and other supportive measures.

The case highlights the possible risk of such rare yet lethal complication of BCG especially at places where it is given routinely at birth or in the neonatal period and also emphasizes the need for neonatal screening for SCID in such regions.

Keywords: Primary immunodeficiency; Adverse event following immunization; Hematopoietic stem cell transplantation; Neonatal screening