A Case of Disseminated Tuberculosis with Prolonged Complications of BCG Vaccination.

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An 11-year-old boy, who was admitted to our hospital because of fever, wheezing and bloody sputum. The erosion after BCG vaccination had persisted for 2 years since the age of 6 months. At the age of 6 years, he had tuberculous lymphadenitis in the left axilla and was improved with anti-tuberculous drugs. On admission, the Mantoux test was strongly positive. The breath sounds were diminished and rales were heared over the left lung. There was old scar fomation on the BCG vaccination. Microscopical examination of repeated smears and several polymerase chain reaction (PCR) revealed no acid-fast bacilli, but two months later, sputum and stool cultures yieldedMycobacterium tuberculosis. In addition, several radiological examinations indicated a diagnosis of disseminated tuberculosis. After administration of anti-tuberculous drugs, he was rapidly improved. Immunological examinations showed an increase in HLA-DR+cells and natural killer cells, an increase in IFN-γ and a decreased T cell blastgenesis by mitogens. Immunodeficiency against BCG or Mycobacterium tuberculosiswas considered from clinical course, but there were no definite data indicating a diagnosis of primary immunodeficiency.
日本小児呼吸器疾患学会の論文