Gharehdaghi Mohammad, Hassani Mohammad, Ghodsi Elaheh, Khooei Alireza, Moayedpour Amir
Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
Arch Bone Jt Surg. 2015 Oct;3(4):291-5.
Tuberculosis is an essential problem for healthcare systems especially in developing countries. All newborns are given Bacillus Calmette-Guérin (BCG) vaccine in Iran which is prepared from live bovine tuberculosis bacillus, and is given to protect against tuberculosis. Osteomyelitis secondary to BCG vaccination is rare and usually involves epiphysis of long tubular bones.
4 patients, 3 males and a female entered this study and were between 11 to 24 months old. The involved bones were first metatarsi, talus, humerus and tibia bone. The main radiologic finding was lytic lesion with cortical destruction and periosteal reaction.
3 patients underwent core needle biopsy and the one with the proximal tibia involvement, underwent open surgery. Pathology report suggested granulomatous osteomyelitis and typical caseous necrosis compatible with tuberculosis. Surgical treatment for these patients was curettage and debridement of the bone lesion and involved tissues around. The patients got standard anti TB pharmacotherapy, were completely cured and no short term complication was seen in a one year follow up.
BCG osteomyelitis and cold abscess, should be kept in mind when assessing a child presenting chronic symptoms like pain, limping or local swelling of extremities. The long interval time between BCG vaccination and outbreak of the culture-negative abscess is a major point which emphasizes on pathologic evaluation. Image guided tissue biopsy and PCR studies confirm diagnosis. Early use of a surgical curettage and debridement along with chemotherapy soon afterwards, enabled these children to enjoy a satisfactory clinical outcome.
结核病是医疗系统面临的一个重要问题，在发展中国家尤为如此。伊朗所有新生儿都接种卡介苗（BCG），该疫苗由活牛结核杆菌制备，用于预防结核病。卡介苗接种后继发骨髓炎较为罕见，通常累及长管状骨的骨骺。
4例患者进入本研究，3例男性和1例女性，年龄在11至24个月之间。受累骨骼分别为第一跖骨、距骨、肱骨和胫骨。主要影像学表现为溶骨性病变伴皮质破坏和骨膜反应。
3例患者接受了粗针活检，1例胫骨近端受累患者接受了开放手术。病理报告提示为肉芽肿性骨髓炎和与结核相符的典型干酪样坏死。这些患者的手术治疗为刮除和清除骨病变及周围受累组织。患者接受了标准的抗结核药物治疗，均完全治愈，在一年的随访中未出现短期并发症。
在评估出现疼痛、跛行或肢体局部肿胀等慢性症状的儿童时，应考虑卡介苗骨髓炎和寒性脓肿。卡介苗接种与培养阴性脓肿发作之间的时间间隔较长是强调病理评估的一个要点。影像引导下的组织活检和PCR研究可确诊。早期进行手术刮除和清创并随后尽快进行化疗，使这些儿童获得了满意的临床结果。
