DISSEMINATED BACILLE CALMETTE-GUERIN DISEASE AFTER VACCINATION - CASE-REPORT AND REVIEW

The attenuated bacille Calmette Guerin (BCG) vaccine is administered t o prevent tuberculosis. Complications of vaccination are uncommon. We report a new ease of disseminated BCG disease and review 27 additional cases identified from a review of >5,000 reports published between 19 80 and 1996. Twenty-four of the 28 total cases were associated with an immune deficiency, including nine cases of AIDS. Seventy-one percent of the eases occurred in children younger than 2 years old. Sixty-eigh t percent of the patients were male. About one-half of the patients we re vaccinated in a developed nation, but 85% of the cases were reporte d from a developed nation. Response to therapy was poor, with an overa ll mortality rate of 71%. We made two new observations. Disseminated B CG disease has historically been a disease of infants, but cases now o ccur in adults and older children coinfected with human immunodeficien cy virus. Cases also occur after revaccination of individuals who were anergic following the initial administration of BCG vaccine. Dissemin ated BCG disease is an uncommon but devastating complication of vaccin ation that should be considered in the appropriate clinical setting. I mmunocompromised infants and patients with late-stage AIDS are at grea test risk and respond poorly to standard therapies.