Norimatsu Yuta, Ito Kazuma, Shiomi Takayuki, Fujii Katsunori, Sugaya Makoto
Department of Dermatology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, JPN.
Department of Dermatology, International University of Health and Welfare Narita Hospital, Narita, JPN.
Cureus. 2025 May 10;17(5):e83857. doi: 10.7759/cureus.83857. eCollection 2025 May.
Japan has a policy of vaccination with Bacillus Calmette-Guerin (BCG) and diphtheria, tetanus, and pertussis, and inactivated polio vaccine (DTP-IPV); however, there are rare reports of psoriasis-like skin rash caused by these vaccines. The mechanism by which psoriasis-like skin rash develops after BCG vaccination is unknown, but it has been suggested that it may occur when BCG vaccination is given to patients infected with tuberculosis. Here, we report a case of psoriatic skin lesions following BCG vaccination in a five-month-old girl with latent tuberculosis infection (LTBI). The child received the BCG vaccine and a third dose of DTP-IPV at five months of age in accordance with the vaccination schedule recommended in Japan. Soon after the vaccination, erythema with pustulation developed at the BCG injection site. Erythematous plaques were also seen, mainly on the trunk. Her father had suffered from tuberculosis when the patient was born, and her mother had LTBI. Therefore, the skin rash on the vaccination site was considered Koch's phenomenon. She was brought to the pediatric department in our hospital to check the infection status of tuberculosis. The tuberculin skin test was positive. A T-cell-based enzyme-linked immunospot assay for tuberculosis was also positive, while there were no abnormalities in the lung field, leading to the diagnosis of LTBI. Treatment with isoniazid was started two weeks after the patient's initial visit to our hospital. Erythematous plaques on the trunk persisted, and the patient was referred to our department six weeks after the initial visit to rule out cutaneous tuberculosis. A skin biopsy revealed psoriasiform acanthosis and Munro's microabscess. No mycobacteria were detected by Ziehl-Neelsen staining, and tissue culture was negative. Therefore, she was diagnosed with psoriatic skin lesions after BCG vaccination. Topical application of maxacalcitol ointment and prednisolone valerate acetate ointment relieved the plaques. No recurrence of skin rash was observed during a five-month follow-up.
日本实行卡介苗（BCG）、白喉、破伤风和百日咳以及灭活脊髓灰质炎疫苗（DTP-IPV）的接种政策；然而，有这些疫苗导致银屑病样皮疹的罕见报告。卡介苗接种后银屑病样皮疹发生的机制尚不清楚，但有人认为，在给感染结核病的患者接种卡介苗时可能会出现这种情况。在此，我们报告一例5个月大患有潜伏性结核感染（LTBI）的女孩接种卡介苗后出现银屑病性皮肤病变的病例。该儿童按照日本推荐的接种计划在5个月大时接种了卡介苗和第三剂DTP-IPV。接种疫苗后不久，卡介苗注射部位出现伴有脓疱的红斑。还可见主要位于躯干的红斑性斑块。患儿出生时其父亲患有结核病，其母亲患有LTBI。因此，接种部位的皮疹被认为是科赫现象。她被带到我院儿科检查结核病感染状况。结核菌素皮肤试验呈阳性。基于T细胞的结核病酶联免疫斑点试验也呈阳性，而肺部未发现异常，从而诊断为LTBI。在患儿首次就诊我院两周后开始使用异烟肼治疗。躯干上的红斑性斑块持续存在，患儿在首次就诊六周后被转诊至我科以排除皮肤结核。皮肤活检显示银屑病样棘层增厚和门罗微脓肿。齐-尼氏染色未检测到分枝杆菌，组织培养为阴性。因此，她被诊断为接种卡介苗后出现银屑病性皮肤病变。外用马沙骨化醇软膏和醋酸泼尼松龙戊酸酯软膏使斑块消退。在5个月的随访期间未观察到皮疹复发。
