BCG Adenitis-Beware of this entity in infants and children after BCG vaccination

Introduction:Bacillus- Calmette–Guerin (BCG) vaccine containing live‑attenuated Mycobacterium bovis was first used in humans in 1921.The minor adverse reactions are local reaction (pain, swelling, redness). Rare vaccine reactions are suppurative lymphadenitis, BCG osteitis and Disseminated BCG infection. Aim of the study: To report the cases of BCG lymphadenitis and other complications diagnosed by FNAC after vaccination.Materials and methods:All the infants and children (1month to 2 years) who presented with regional lymphadenopathy for FNAC after BCG vaccination and other rare vaccine reactions were included in the study.Results:Total of 21 cases of BCG lymphadenitis was found during 3 years period ranging from 2.5 months of age to 2 years. Mean age of presentation was 9.3 months. Male: Female ratio was 1.6:1. Most common site was left axillary lymph nodes (90%) and one case each at left supraclavicular (5%), and left cervical areas (5%). Most of the cases are diagnosed as suppurative granulomatous lymphadenitis (95%) on FNAC and one case were diagnosed as nonsuppurative granulomatous lymphadenitis (5%). Z-N stain was done in 18 out of 21 cases and it is positive in 13 cases (72.3%) and it was noncontributory in five cases (27.7%).Other rare vaccine reactions encountered are a single case of BCG induced abscess at vaccination site, one case each of right and left inguinal lymphadenopathy with disseminated BCG infection. Conclusion:A high index of clinical suspicion,FNAC combined with clinical correlation, is useful for diagnosis and management of BCG Lymphadenitis. &nbsp