Abramowsky C, Gonzalez B, Sorensen R U
Department of Pathology, Emory University School of Medicine, Atlanta, Georgia.
Am J Clin Pathol. 1993 Jul;100(1):52-6. doi: 10.1093/ajcp/100.1.52.
The pathologic findings from biopsy or autopsy material in four patients, who were vaccinated with bacillus Calmette-Guérin (BCG) at birth in Chile, are presented. Two patients had severe combined immunodeficiency, and two had more restricted cellular (T-cell) immunodeficiency with no evidence of human immunodeficiency virus infection. The patients had distinct skin nodules and nodular lesions in systemic organs and bone marrow. Three patients had regional BCG lymphadenitis. One patient with severe combined immunodeficiency, however, had disseminated BCG without any local reaction. In all cases BCG strains of Mycobacterium were identified in a reference mycobacteriology laboratory. The histologic lesions in most patients usually consisted of diffuse histiocytic infiltrates with poorly formed granulomas and variable or no necrosis. Histiocytes were plump and engorged with numerous acid-fast bacilli (AFB). In some areas the massive histiocytosis resembled a spindle cell neoplasm. Other histologic findings supported the underlying immunodeficiency. The pattern of histiocytic response and degree of microbial killing depend on the host's immunocompetence. In the later stages of disease or in severe immunodeficiency, there is a lack of granuloma formation and unimpeded proliferation of AFB. These findings are reminiscent of nontuberculous mycobacterial infections in AIDS patients. Bacillus Calmette-Guèrin dissemination has to be considered in immunocompromised individuals when the patient comes from other countries in which such vaccinations are practiced.
本文报告了4例在智利出生时接种卡介苗（BCG）的患者，其活检或尸检材料的病理结果。2例患者患有严重联合免疫缺陷，2例患者有更局限的细胞（T细胞）免疫缺陷，且无人类免疫缺陷病毒感染证据。这些患者在全身器官和骨髓中有明显的皮肤结节和结节性病变。3例患者有局部卡介苗淋巴结炎。然而，1例严重联合免疫缺陷患者发生了播散性卡介苗感染，且无任何局部反应。在所有病例中，均在参考分枝杆菌学实验室鉴定出分枝杆菌的卡介苗菌株。大多数患者的组织学病变通常由弥漫性组织细胞浸润组成，伴有形成不良的肉芽肿，坏死程度不一或无坏死。组织细胞饱满，充满大量抗酸杆菌（AFB）。在某些区域，大量组织细胞增生类似于梭形细胞瘤。其他组织学发现支持潜在的免疫缺陷。组织细胞反应模式和微生物杀伤程度取决于宿主的免疫能力。在疾病后期或严重免疫缺陷时，缺乏肉芽肿形成，抗酸杆菌不受阻碍地增殖。这些发现让人联想到艾滋病患者的非结核分枝杆菌感染。当患者来自其他实施此类疫苗接种的国家时，免疫功能低下的个体必须考虑卡介苗播散的情况。
