BCGワクチンによる幼児の上腕骨骨髄炎の1例

Osteomyelitis of the Humerus as a Complication of Bacille Calmette-Guérin Vaccination in an Infant. Case Report

　症例は12カ月の男児で，生後3カ月でBacille Calmette-Guérin(BCG)ワクチンを接種された．その9カ月後，感冒様症状が先行した後，右肩を動かさなくなり，単純X線像で右上腕骨近位部に骨溶解像を認めた．針生検で結核菌PCRが陽性となり，遺伝子解析によりウシ型結核菌であるBCG東京株と判明し，右上腕骨BCG骨髄炎と診断した．抗結核薬(INH，RFP)の投与と病巣掻爬を行った．術後1年現在，骨髄炎の再発や成長障害は認めていない．幼小児期の骨髄炎の鑑別においてはBCG菌を考慮する必要がある．

　We report the case of a 12-month-old male infant who developed osteomyelitis of the humerus as a complication of Bacille Calmette-Guérin (BCG) vaccination.　BCG vaccination had been performed at 3 months of age, and the patient presented with right shoulder pain and a slight fever 9 months after the vaccination.　A plain X-ray films showed osteolytic change in the right proximal humerus.　Histopathological examination of a needle biopsy specimen showed inflammatory tissue with caseous necrosis, and a DNA analysis by the polymerase chain reaction (PCR) method revealed Mycobacterium bovis Tokyo strain, thereby confirming the diagnosis of BCG osteomyelitis.　Antituberculous chemotherapy (isoniazid and rifampicin) was instituted, and then curettage of the osteolytic lesion in the right humerus was performed.　At the 12-month follow-up examination the patient was pain-free with no evidence of a recurrence, and X-rays showed healing of the lesion in the humerus.　BCG osteomyelitis should be suspected in infants with osteomyelitis and a history of BCG vaccination.