Case data

Sistema Musculoesquelético

Emergency

EXTENSIVE FOREARM ABSCESS AFTER INADVERTENT APPLICATION OF BCG VACCINE

129
Ensino
Tipo Caso 1
  • Flávia Sprenger - HOSPITAL DE CLÍNICAS - UFPR
  • Lais de Medeiros - HOSPITAL DE CLÍNICAS - UFPR
  • Arquimedes Artur Zorzetto - HOSPITAL DE CLÍNICAS - UFPR
-
4/24/2020
5/26/2020
Masculino , 49 anos
Abscesso, Tuberculose Cutânea

Abstract

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.

Clinical History

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)

Radiological findings

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).

Discussion

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.

List of Advantages

  • bacterial abscess
  • cellulitis
  • necrotising fasciitis

Diagnosis

  • micobacterial subcutaneous abscess

Learning

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.

References

  • 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.

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