Adenitis due to BCG vaccine: a case report

Abstract

Introduction: The Portuguese national vaccination plan recommends the Bacillus Calmette–Guérin (BCG) vaccine against tuberculosis for all newborn babies, except if there are specific contraindications. The main complication of BCG vaccine is lymphadenitis that can occur within 6 months after vaccination. Case description: A two-month old infant born after a full-term pregnancy presented at a routine consultation with left axillary lymphadenitis. The rest of the physical examination was normal. A diagnosis of BCG lymphadenitis diagnosis was made and the patient was referred to the local emergency service for observation. Conservative treatment was recommended. Faced with large lymphadenopathy, signs of inflammation, and the baby’s distress, the mother made frequent visits to the health center to show the evolution of the adenitis and to ask whether anything else could be done, aside from the administration of the analgesics. The child presented again with fluctuation and spontaneous drainage of the lymph nodes after 3 weeks. Eventually all symptoms resolved. The child was seen at 18 months old of age with a healed scar in the left axilla. Commentary: This case demonstrates the benign nature of BCG lymphadenitis. The vast majority of cases require conservative treatment. Referral is necessary only if there are complications that might require aspiration or surgical drainage. It can be difficult to reassure parents when presented with such a striking condition and the recommended course of action is analgesia and patience, as symptoms resolve spontaneously.