Diffuse hyperpigmented subcutaneous nodules as a primary manifestation of disseminated bacillus Calmette-Guerin disease in young infants

Abstract

Introduction: There are increasing reports of serious adverse events of bacillus Calmette-Guerin (BCG) vaccination in infants with unrecognized primary immunodeficiency disorders (PIDs) in our country. Among these adverse events skin manifestations occur less frequently and are less noticed. Case Presentation: We report on an 11-months-old boy with prolonged fever and diffuse hyperpigmented subcutaneous nodules. Due to lymphopenia, oral thrush and severe adverse reaction to BCG vaccination, the possibility of primary immunodeficiency was considered for him and immunological investigations were done. Conclusions: Subcutaneous nodules in the absence of a local reaction at the site of BCG vaccination may be the sole manifestation of disseminated BCG disease.