title: Surgical treatment of an infant with Bacille Calmette-Guérin osteomyelitis extending across the growth plate.
abstract: Bacille Calmette-Guérin osteomyelitis in infants is a known complication of Bacille Calmette-Guérin vaccination. Treatment consists of antituberculosis chemotherapy after biopsy/curettage; however, in cases of Bacille Calmette-Guérin osteomyelitis extending to the growth plate and epiphysis, the extent and time of surgical treatment such as curettage/biopsy is unknown because of bone growth disturbances. This article presents a case of an infant with this type of Bacille Calmette-Guérin osteomyelitis at the proximal tibia. A metaanalytic review was performed for possible risk factors of its recurrence. In our patient, primary curettage of partial lesion, excluding the part extending to the growth plate and epiphysis, failed, and recurettage of the extended lesion involving the growth plate and epiphysis was required for its eradication, resulting in bone growth disturbance. In the metaanalysis, 7 literatures reporting 14 cases of Bacille Calmette-Guérin osteomyelitis extending to the growth plate and epiphysis were included. Although statistical analysis showed no significant risk factors associated with the recurrence, these cases showed high recurrence rate in approximately 55.6%, requiring reoperation. Generally, the smaller damage to the growth plate can minimize bone growth disturbance. Taken together, it is suggested that Bacille Calmette-Guérin osteomyelitis extending to the growth plate and epiphysis is associated with high recurrence rate, and early curettage of the entire lesion should be performed to eradicate it and avoid resulting complications.
authors.affiliation: Department of Orthopedic Surgery, Takayama Redcross Hospital, Gifu, Japan.
authors.forename: Daichi
authors.initials: D
authors.lastname: Ishimaru
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ogawa
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Ito
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shimizu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000009:adverse effects*; D018786:Bone Substitutes / Q000008:administration & dosage; D003475:Curettage; D017886:Durapatite / Q000008:administration & dosage; D006132:Growth Plate / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007538:Isoniazid / Q000627:therapeutic use; D007719:Knee Joint / Q000601:surgery; D008297:Male; D015201:Meta-Analysis as Topic; D010019:Osteomyelitis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D011718:Pyrazinamide / Q000627:therapeutic use; D012008:Recurrence; D012086:Reoperation; D012293:Rifampin / Q000627:therapeutic use; D013977:Tibia / Q000382:microbiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D001500:BCG Vaccine; D018786:Bone Substitutes; D011718:Pyrazinamide; D017886:Durapatite; D007538:Isoniazid; D012293:Rifampin