An infant with disseminated bacillus Calmette-Guerin infection (BCGitis)

The bacillus Calmette Guerin (BCG) vaccine contains live attenuated Mycobacterium bovis bacteria. There is a long-standing controversy surrounding the efficacy of BCG against TB and whether it should be used. BCG is associated with significant adverse effects, including life-threatening disseminated BCG infection in children with primary immunodeficiency (PID). Here, we present a case report of an infant diagnosed with severe combined immunodeficiency disease and disseminated BCGitis. There are no clear guidelines for the most suitable treatment for disseminated BCG disease. Hematopoietic stem cell transplantation (HSCT) is needed in urgent cases. BCGitis is known to exacerbate clinically after HSCT while immune reconstitution occurs. During this time, rapidly expanding peripheral T cells of the graft result in a severe inflammatory response, lymphadenitis, multiple abscesses, and sepsis, and fatal multiple organ failure is possible. Modification of the transplant procedure and the use of immunosuppressive medications and prednisolone to treat cytokine reactions at the time of overwhelming immune reconstitution are usually necessary.