Lupus vulgaris as a form of cutaneous TB caused by the Bacille Calmette-Guérin vaccine
a pediatric case
Abstract
Cutaneous TB is a rather unusual chronic infectious disease caused by Mycobacteriun tuberculosis. There are several forms of cutaneous infection, lupus vulgaris being the most frequent and ordinary one in developed countries. Clinical variations will depend on the site of infiltration of the skin by the bacillus, the patient’s immune condition and the environment. In the case of lupus vulgaris, apart from Mycobacteriun tuberculosis, M. bovis may be involved, and the Bacille Calmette Guérin involvement is less frequent. The latter presents a chronic evolution, being progressive and unusual in children.
The study presents the case of a girl who was diagnosed with a form of cutaneous tuberculosis called lupus vulgaris caused by the Bacille Calmette-Guérin vaccine.
Clinical case:
a 10 year old girl who evidenced skin lesions of different kinds, of slow evolution and asymptomatic: the largest one was in the external part of the right deltoid muscle as an erythematous plaque of 20 by 10 cm with higher borders evidencing micro papules in the center that coalesce leaving a central atrophy zone. The latter had started in the neonatal stage after the Bacille Calmette-Guérin vaccine. For three years she had evidenced a second smaller lesion in the outer face of the right thigh of similar characteristics and other multiple lesions in the back with the shape of vinous red micro papules. Assessment tests were generally normal, as well as the chest and limbs X-ray. The tuberculin test evidenced a 15 mm induration and smears were negative. The deltoid muscle skin lesion biopsy showed caseous granulomas and molecular techniques diagnosed attenuated Mycobacteriumbovis. Given that diagnose the patient received anti-TB treatment during 10 months, tolerance being good and the lesions improved.
References
(1) Bisero E, Luque G, Melillo K, Favier M, Zapata A, Cuello M. Tuberculosis cutánea: reporte de un caso. Arch Argent Pediatr 2014; 112(3):e93-6.
(2) Jaka-Moreno A, López-Nuñez M, López-Pestaña A, Tuneu-Valls A. Lupus vulgar causado por Mycobacterium bovis. Actas Dermosifiliogr 2012; 103(3):251-3.
(3) Panzarelli A. Tuberculosis cutánea. Derm Venez 1988; 36(2):45-51.
(4) Tincopa Wong O, Sanchez-Saldaña L. Tuberculosis cutánea. Dermat peru 2003; 13(3):195-214.
(5) Almaguer-Chávez J, Ocampo-Candiani J, Rendón A. Panorama actual en el diagnóstico de la tuberculosis cutánea. Actas Dermosifiliogr 2009; 100:562-70.
(6) Contrera M. Situación epidemiológica de la tuberculosis en Uruguay. En: Comisión Honoraria de la Lucha Antituberculosa. Ministerio de Salud Pública. Universidad de la República. Facultad de Medicina. Cátedras de Enfermedades Infecciosas y de Neumología. Guía Nacional para el Manejo de la Tuberculosis. 3 ed. Montevideo: CHLA-EP, 2016:17-21.
(7) Afsar FS, Afsar I, Diniz G, Asilsoy S, Sorguc Y. Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis. Braz J Infec Dis 2008; 12(2):152-4.
(8) Najem NM, Zadeh VB, Al-Abdulrazzaq AH, Al-Otaibi SR, Kadyan S, Joneja M. Bacillus Calmette-Guérin vaccine induced lupus vulgaris in a child. Acta Dermatovenerol Alp Pannonica Adriat 2009; 18(4):195-7.
(9) Strickler A, Pérez A, Risco M, Gallo S. Enfermedad por bacilo de Calmette-Guérin (BCG) y deficiencia del receptor b-1 de interleuquina 12: experiencia clínica de dos casos en una familia y un caso aislado. Rev chil infectol 2014; 31(4):444-51.
(10) Venkataraman A, Yussuff M, Liebeschuetz S, Riddell A, Prendergast AJ. Management and outcome of Bacille Calmette-Guérin vaccine adverse reactions. Vaccine 2015; 33:5470-4.
(11) Spelta K, Diniz L. Cutaneous tuberculosis: a 26-year restrospective study in a endemic área of tuberculosis, Vitória, Espírito Santo, Brazil. Rev Inst Med Trop Sao Paulo 2016; 58:49.
(12) Motta A, Feliciani C, Toto P, De Benedetto A, Morelli F, Tulli A. Lupus vulgaris developing at the site of misdiagnosed scrofuloderma. J Eur Acad Dermatol Venereol 2003; 17(3):313-5.
(13) Yanine D, Latorres M, Campos F, Orozco C. Tuberculosis cutánea: revisión del tema a propósito de dos casos. Rev Chilena Dermatol 2015; 31(2):155-60.
(14) Gómez Sierra M, Bolomo G, Ibañez M, Miraglia E, Campoy V, Palazzolo J, et al. Tuberculosis cutánea: lupus vulgar. Arch Argent Dermatol 2016; 66(3):82-5.
(15) Pizzariello G, Fernández Pardal P, D`Atri G, Novac V, Uranga A. Espectro clínico de la tuberculosis cutánea. Rev Argent Dermatol 2008; 89:177-87.
(16) Bhardwaj P, Mahajan V. Lupus vulgaris. Indian Pediatr 2003; 40:902-3.
(17) Meltem Akkurt Z, Uçmak D, Fidan V, Türkcü G. Tuberculide papulonecrótica: caso clínico. Arch Argent Pediatr 2013; 111(1):e5-7.
(18) Concha M, Fich F, Rabagliati R, Pinto C, Rubio R, Navea O, et al. Tuberculosis cutánea: reporte de dos casos y revisión de la literatura. Rev Chil Infectol 2011; 28(3):262-8.
(19) Lussier N, Bourgault A, Gaundreau C, Turgeon P. A complication of BCG vaccine: a case of localized cutaeous abscess due to Mycobacterium bovis. Can J Infect Dis 1999; 10(3):257-9.
(20) Hesseling A, Rabie H, Marais J, Manders M, Lips M, Schaaf S, et al. Bacille Calmette-Guérin vaccine-induced disease in HIV-infected and HIV-uninfected children. Clin Infect Dis 2006; 42:548-58.
(21) Organización Mundial de la Salud. Hoja de información sobre las tasas observadas de reacciones a vacunas: vacuna bacilo de Calmette-Guérin (BCG). Ginebra: OMS, 2012. Disponible en: http://www.who.int/vaccine_safety/initiative/tools/BCG_Vaccine_rates_information_sheet_ES.pdf (Consulta: 26 marzo 2018).
(22) Bellet JS, Prose NS. Skin complications of Bacillus Calmette-Guérin inmunization. Curr Opin Infect Dis 2005; 18(2):97-100.
(23) Santos A, Dias A, Cordeiro A, Cordinhã C, Lemos S, Rocha G, et al. Severe axillary limphadenitis after BCG vaccination: alert for primary immunodeficiencies. J Microbiolol Inmunol Infect 2010; 43(6):530-7.
