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Papulonecrotic tuberculid‐like eruptions after Bacille Calmette‐Guerin vaccination
Author(s) -
TAKADA Tomoaki,
YAMASHITA Toshiharu,
SATO Makito,
KAWAKAMI Yoshiaki,
TOMINAGA Akihiro,
ONO Ichiro,
JIMBOW Mihoko,
TSUTSUMI Hiroyuki,
JIMBOW Kowichi
Publication year - 2007
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/j.1346-8138.2007.00246.x
Subject(s) - medicine , tuberculosis , vaccination , immunology , pathology , cd8 , immune system
One of the specific skin lesions occurring after Bacille Calmette‐Guerin (BCG) vaccination is generalized tuberculid‐like eruptions, which occur rarely, but have a tendency to heal spontaneously. Their pathogenesis and relationship to “true” tuberculids are poorly understood. This report presents a case of a 6‐month‐old girl who developed generalized papulonecrotic tuberculid‐like eruptions after BCG vaccination. The skin lesions healed spontaneously in 3 months. Culture of blood, gastric juice and reverse transcription polymerase chain reaction (RT‐PCR) of papulonecrotic skin biopsies were all negative for Mycobacterium tuberculosis . Histopathology of papulonecrotic eruptions revealed marked epidermal necrosis, perivascular lymphocytic infiltrates and epidermotropic infiltration of lymphocytes showing markers of CD3 + lymphocytes (90–95% of all infiltrating cells), CD4 + (40–50%), CD8 + (40–50%), and CD45RO + (70%). In contrast, the BCG vaccination site revealed intradermal granuloma with epithelioid cells, occasional giant cells and infiltration of lymphocytes consisting of CD3 + (60–70%), CD4 + (40–50%), CD8 + (30–40%), CD45RO + (40%), CD79a + (30–40%), and CD20 + (20–30%). Our patient did not reveal any signs indicative of tuberculosis. Papulonecrotic lesions were therefore called papulonecrotic tuberculid‐like eruptions, rather than tuberculids, that occurred after BCG vaccination and appeared to derive from a hypersensitive reaction mediated by immune lymphocytic infiltration.