Lymphadenitis caused by infection with an isoniazid- and rifampin-resistant strain of Mycobacterium bovis BCG in an infant with IFN-γ/IL-12 pathway defect.
We report a rare case in a female infant (age, 3.5 months) with primary immunodeficiency (IFN-γ/IL-12 pathway defect) who presented with suppurative lymphadenitis after Mycobacterium bovis BCG vaccination. The strain of M. bovis BCG identified was found to be resistant to isoniazid and rifampin. The patient was treated with a special pharmacological regimen involving isoniazid (in a limited, strategic manner), ethambutol, streptomycin, and IFN-γ, after which there was complete resolution of the lesions.
School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Lilian Martins Oliveira
LM
Diniz
School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Tiago
T
Guimarães
School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Maria das Graças Rodrigues de
Md
Oliveira
School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Jorge Andrade
JA
Pinto
School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Silvana Spindola de
SS
Miranda
D000995:Antitubercular Agents / Q000494:pharmacology; D001500:BCG Vaccine / Q000009:adverse effects*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000276:immunology; D007223:Infant; D007371:Interferon-gamma / Q000378:metabolism; D018664:Interleukin-12 / Q000378:metabolism; D007538:Isoniazid / Q000494:pharmacology; D008199:Lymphadenitis / Q000382:microbiology*; D009163:Mycobacterium bovis / Q000187:drug effects*; D012293:Rifampin / Q000494:pharmacology
D000995:Antitubercular Agents; D001500:BCG Vaccine; D018664:Interleukin-12; D007371:Interferon-gamma; D007538:Isoniazid; D012293:Rifampin