title: Papulonecrotic tuberculid-like eruptions after Bacille Calmette-Guerin vaccination.
abstract: One of the specific skin lesions occurring after Bacille Calmette-Guerin (BCG) vaccination is generalized tuberculid-like eruptions, which occur rarely, but have a tendency to heal spontaneously. Their pathogenesis and relationship to "true" tuberculids are poorly understood. This report presents a case of a 6-month-old girl who developed generalized papulonecrotic tuberculid-like eruptions after BCG vaccination. The skin lesions healed spontaneously in 3 months. Culture of blood, gastric juice and reverse transcription polymerase chain reaction (RT-PCR) of papulonecrotic skin biopsies were all negative for Mycobacterium tuberculosis. Histopathology of papulonecrotic eruptions revealed marked epidermal necrosis, perivascular lymphocytic infiltrates and epidermotropic infiltration of lymphocytes showing markers of CD3(+) lymphocytes (90-95% of all infiltrating cells), CD4(+) (40-50%), CD8(+) (40-50%), and CD45RO(+) (70%). In contrast, the BCG vaccination site revealed intradermal granuloma with epithelioid cells, occasional giant cells and infiltration of lymphocytes consisting of CD3(+) (60-70%), CD4(+) (40-50%), CD8(+) (30-40%), CD45RO(+) (40%), CD79a(+) (30-40%), and CD20(+) (20-30%). Our patient did not reveal any signs indicative of tuberculosis. Papulonecrotic lesions were therefore called papulonecrotic tuberculid-like eruptions, rather than tuberculids, that occurred after BCG vaccination and appeared to derive from a hypersensitive reaction mediated by immune lymphocytic infiltration.
authors.affiliation: Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Takada
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamashita
authors.forename: Makito
authors.initials: M
authors.lastname: Sato
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawakami
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tominaga
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ono
authors.forename: Mihoko
authors.initials: M
authors.lastname: Jimbow
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsumi
authors.forename: Kowichi
authors.initials: K
authors.lastname: Jimbow
mesh_terms: D001500:BCG Vaccine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D009336:Necrosis; D012867:Skin / Q000473:pathology*; D017444:Skin Diseases, Papulosquamous / Q000209:etiology* / Q000473:pathology*; D014611:Vaccination / Q000009:adverse effects
chemical_list: D001500:BCG Vaccine