A case of papular tuberculid and suppurative lymphadenitis after BCG vaccination

Various dermatological complications have been reported following the BCG vaccination although this vaccination has been recommended to all healthy infants in our country. A 4-months-old boy, who had a BCG vaccination three weeks after birth, developed erythematous papules and pustules on the whole body, especially on the face and upper extremities. Two erythematous subcutaneous soft nodules were also noted on the left side of the neck. A biopsy specimen from the right forearm revealed caseous necrosis surrounded by a granulomatous inflammation consisting of epithelioid cells and lymphocytes. It was centered along the axis of the damaged pilosebaceous follicle. No acid-fast bacilli could be demonstrated by AFB stain. A marked improvement of his skin eruptions was observed after anti-tuberculosis medication. However, nodules in the cervical area perforated spontaneously and healed leaving scars several months after the cutaneous eruptions subsided. The clinical and histologic findings and a good response to anti-tuberculous therapy support the diagnosis of papular tuberculid and suppurative lymphadenitis after BCG vaccination.