title: Necrotic Tuberculin Skin (Mantoux) Test Reaction: A Case Report and an Estimation of Frequency.
abstract: Tuberculin skin testing was performed on a 5-year-old girl in Phnom Penh, Cambodia. She had been immunized by Bacille de Calmette et Guérin. She was tested because of a palpable cervical node and a slightly elevated temperature. Within 48 h, a deep necrotic lesion appeared on the volar aspect of the left arm. The lesion was treated locally, and the child was not treated for suspected TB. To our knowledge, this is the first instance of necrosis in 11,392 people who received Tubersol doses since 1996 to date at our International Vaccination Center, for an estimated incidence of 0.18 per 1,000 (95% Poisson 0.04-0.70 per 1,000 doses used). At a follow-up consultation after 77 days, the lesion had scarred and the child showed no signs suggestive of active TB. Although latent TB infection remains the most likely diagnosis, other types of mycobacterial infection may be considered in the tropical setting and in the absence of signs suggestive of active TB.
authors.affiliation: Epidemiology and Public Health Unit, Phnom Penh, Cambodia.
authors.forename: Dim
authors.initials: D
authors.lastname: Bunnet
authors.affiliation: Clinical Laboratory, Phnom Penh, Cambodia; Clinical Laboratory, Phnom Penh, Cambodia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kerleguer
authors.affiliation: Institut Pasteur du Cambodge; and the National Pediatric Hospital, Phnom Penh, Cambodia.
authors.forename: Peou
authors.initials: P
authors.lastname: Kim
authors.affiliation: Immunology Unit, Phnom Penh, Cambodia.
authors.forename: Polidy
authors.initials: P
authors.lastname: Pean
authors.affiliation: Epidemiology and Public Health Unit, Phnom Penh, Cambodia; International Vaccination Center, Phnom Penh, Cambodia.
authors.forename: Viseth
authors.initials: V
authors.lastname: Phuong
authors.affiliation: Epidemiology and Public Health Unit, Phnom Penh, Cambodia; International Vaccination Center, Phnom Penh, Cambodia.
authors.forename: Nayyim
authors.initials: N
authors.lastname: Heng
authors.affiliation: Epidemiology and Public Health Unit, Phnom Penh, Cambodia; International Vaccination Center, Phnom Penh, Cambodia.
authors.forename: Yiksing
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Epidemiology and Public Health Unit, Phnom Penh, Cambodia.
authors.forename: Laurence
authors.initials: L
authors.lastname: Borand
authors.affiliation: International Vaccination Center, Phnom Penh, Cambodia. Electronic address: atarantola@pasteur-kh.org.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Tarantola
mesh_terms: D002160:Cambodia; D002675:Child, Preschool; D003875:Drug Eruptions / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D007202:Indicators and Reagents / Q000009:adverse effects; D014373:Tuberculin / Q000009:adverse effects*; D014374:Tuberculin Test / Q000009:adverse effects*
chemical_list: D007202:Indicators and Reagents; D014373:Tuberculin