MYCOBACTERIUM-BOVIS LYMPHADENITIS COMPLICATING BCG IMMUNIZATION IN ANINFANT WITH SYMPTOMATIC HIV-1 INFECTION

A 3-month-old infant with HIV-1 infection who recently immigrated from Ethiopia developed regional lymphadenitis and systemic symptoms subse quent to BCG immunization. She was suffering from axillary lymphadenit is ipsilateral to the BCG vaccination site, failure to thrive, unresol ving fever and hepatosplenomegaly. Acid-fast bacilli were seen on stai ning and Mycobacterium bovis was isolated from the regional lymph node . The infant responded promptly to triple antituberculous therapy but died 2 months later from overwhelming pneumonia and respiratory failur e. This case emphasizes the iatrogenic hazards of BCG immunization in HIV-1 infected infants. With the increasing prevalence of pediatric HI V-1 infection, indiscriminate BCG immunization programs should be reco nsidered. While infants with asymptomatic HIV-1 infection at risk for tuberculosis should be immunized, BCG immunization should be withheld in those with symptomatic disease.