• ISSN (On-line) 2965-1980

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Sistema Musculoesquelético

EXTENSIVE FOREARM ABSCESS AFTER INADVERTENT APPLICATION OF BCG VACCINE

Arquimedes Artur Zorzetto 1, Flávia Sprenger 2, Lais de Medeiros 3

Resumo

We report a case of a severe complication of an inadverted application of a widely used vaccine in Brazil. Radiographs of the upper left limb showed significant soft tissue edema and skin bulging, with no signs of bone involvement. Ultrasonography showed a large anechoic collection with thin debris and diffusely thickened wall.

Dados do caso

Masculino 49 anos

Palavras chaves

Abscesso, Tuberculose Cutânea

Histórico Clínico

Forty-nine-year-old male higid patient presented for a yellow fever vaccine application. Due to local pain after the procedure, the patient returned to the health care service, where it was found that a dose of BCG vaccine was administered. Painful and progressive bulging developed, with no response to isoniazid treatment (Figure 1)

Achados Radiológicos

Radiographs of the upper left limb showed significant soft tissue edema and skin bulging, with no signs of bone involvement (Figure 2). Ultrasonography showed a large anechoic collection with thin debris and diffusely thickened and irregular walls, with no detectable flow in Color Doppler mode, affecting entirely the subcutaneous tissue of the posterior aspect and partially the anterior aspect of the left forearm. Local muscles were preserved but compressed by the collection. The abscess’s exact volume was immeasurable by the exam, extending for approximately 13 centimeters in the craniocaudal axis and five centimeters thick (Figure 3).

Discussão

The patient was referred for surgical drainage, with approximately one liter of thick purulent discharge coming out. Then, he was discharged with a Penrose drain and antibiotics. BCG vaccine has the highest adverse reaction rate in our vaccination calendar, being the warm abscess the most reported one. When the vaccine is applied in subcutaneous tissue, the likelihood of side effects increases significantly [1]. This case report highlights the importance of paying close attention in the application technique by health care professionals, especially in moments of increased demand, such as during mass vaccination campaigns.

Lista de Diferenciais

  • bacterial abscess
  • cellulitis
  • necrotising fasciitis

Diagnóstico

  • micobacterial subcutaneous abscess

Aprendizado

With this report we learned to familiarize with severe complications of population vaccination, specially the BCG due to its large use and high rate of complications. It is fundamental to radiologists to be alert to further complications such as compartmental syndrome, bone or muscle involvement and fistulization.

Referências

  • 1. Tural-Kara T, Ozdemir H, Erat T, Yahsi A, Ciftci E. Local Cutaneous Complications After Bacille Calmette-Guerin Vaccine: Experience of a Single Center. International Journal of Clinical Pediatrics 2017; 6(3): 37-41.

Imagens

Figure 1: Ectoscopy showing important bulging and flogistic signs on the left forearm.

Figure 2: Left upper limb radiograph limb with significant soft tissue edema and skin bulging, with no signs of bone involvement.

Figure 3: Ultrasonography imaging revealing a large anechoic collection with thin debris and diffusely thickened and irregular walls, with no detectable flow in Color Doppler mode, affecting entirely the subcutaneous tissue of the posterior aspect and partially the anterior aspect of the left forearm. Local muscles were preserved.

Vídeos

Artigo recebido em sexta-feira, 24 de abril de 2020

Artigo aprovado em terça-feira, 26 de maio de 2020

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