PDF herunterladen
J Pediatr Infect Dis 2020; 15(01): 048-052
DOI: 10.1055/s-0037-1620272
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Intracranial Calcification after Probable Disseminated Bacillus Calmette–Guérin Infection in a Child with Severe Combined Immunodeficiency

Isil Eser
1   Division of Pediatric Allergy and Immunology, Kocaeli University, Kocaeli, Turkey
,
Zeynep Seda Uyan
2   Division of Pediatric Pulmonology, Kocaeli University, Kocaeli, Turkey
,
Suar Caki Kilic
3   Pediatric Stem Cell Transplantation Unit, Bahcesehir University, School of Medicine, Medical Park Goztepe Hospital, Istanbul, Turkey
,
Emek Uyur
4   Division of Pediatric Neurology, Kocaeli University, Kocaeli, Turkey
,
Emin Sami Arisoy
5   Division of Pediatric Infectious Diseases, Kocaeli University, Kocaeli, Turkey
,
Gulsun Tezcan
3   Pediatric Stem Cell Transplantation Unit, Bahcesehir University, School of Medicine, Medical Park Goztepe Hospital, Istanbul, Turkey
,
Metin Aydogan
1   Division of Pediatric Allergy and Immunology, Kocaeli University, Kocaeli, Turkey
› Institutsangaben
Weitere Informationen

Publikationsverlauf

03. Oktober 2017

11. Dezember 2017

Publikationsdatum:
16. Januar 2018 (online)

    Lizenzen und Reprints

Abstract

Bacillus Calmette–Guérin (BCG) vaccine is administered to infants in countries with a high prevalence of tuberculosis. Severe combined immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency disease, rendering patients prone to disseminated BCG infection. Early intensive antimycobacterial treatment and bone marrow transplantation may be lifesaving in patients with BCG infection and SCID. The central nervous system is rarely involved in BCG infection. We report a case of disseminated BCG infection with diffuse intracranial calcification, including periventricular white matter, subcortical area, pons and cerebellar white matter after bone marrow transplantation.

Keywords

severe combined immunodeficiency - disseminated BCG infection - intracranial calcification - central nervous system
 

  • References

  • 1 World Health Organization. BCG vaccine. WHO position paper [Article in English, French]. Wkly Epidemiol Rec 2004; 79 (04) 27-38
    PubMedGoogle Scholar
  • 2 Casanova JL, Blanche S, Emile JF. , et al. Idiopathic disseminated bacillus Calmette-Guérin infection: a French national retrospective study. Pediatrics 1996; 98 (4 Pt 1): 774-778
    PubMedGoogle Scholar
  • 3 Gonzalez B, Moreno S, Burdach R. , et al. Clinical presentation of Bacillus Calmette-Guérin infections in patients with immunodeficiency syndromes. Pediatr Infect Dis J 1989; 8 (04) 201-206
    PubMedGoogle Scholar
  • 4 Casanova JL, Jouanguy E, Lamhamedi S, Blanche S, Fischer A. Immunological conditions of children with BCG disseminated infection. Lancet 1995; 346 (8974): 581
    PubMedGoogle Scholar
  • 5 Notarangelo LD. Primary immunodeficiencies. J Allergy Clin Immunol 2010; 125 (02) (Suppl. 02) S182-S194
    CrossrefPubMedGoogle Scholar
  • 6 Bernatowska EA, Wolska-Kusnierz B, Pac M. , et al. Disseminated bacillus Calmette-Guérin infection and immunodeficiency. Emerg Infect Dis 2007; 13 (05) 799-801
    CrossrefPubMedGoogle Scholar
  • 7 Marciano BE, Huang CY, Joshi G. , et al. BCG vaccination in patients with severe combined immunodeficiency: complications, risks, and vaccination policies. J Allergy Clin Immunol 2014; 133 (04) 1134-1141
    CrossrefPubMedGoogle Scholar
  • 8 Ying W, Sun J, Liu D. , et al. Clinical characteristics and immunogenetics of BCGosis/BCGitis in Chinese children: a 6 year follow-up study. PLoS One 2014; 9 (04) e94485
    CrossrefPubMedGoogle Scholar
  • 9 Sharifi Asadi P, Aghamohammadi A, Mahmoudi S, Pourakbari B, Saboui F, Mamishi S. Clinical, laboratory and imaging findings of the patients with disseminated bacilli Calmette-Guerin disease. Allergol Immunopathol (Madr) 2015; 43 (03) 254-258
    CrossrefPubMedGoogle Scholar
  • 10 Talbot EA, Perkins MD, Silva SF, Frothingham R. Disseminated bacille Calmette-Guérin disease after vaccination: case report and review. Clin Infect Dis 1997; 24 (06) 1139-1146
    CrossrefPubMedGoogle Scholar
  • 11 Hesseling AC, Rabie H, Marais BJ. , et al. Bacille Calmette-Guérin vaccine-induced disease in HIV-infected and HIV-uninfected children. Clin Infect Dis 2006; 42 (04) 548-558
    CrossrefPubMedGoogle Scholar
  • 12 Livingston JH, Stivaros S, Warren D, Crow YJ. Intracranial calcification in childhood: a review of aetiologies and recognizable phenotypes. Dev Med Child Neurol 2014; 56 (07) 612-626
    CrossrefPubMedGoogle Scholar
  • 13 DeLance AR, Safaee M, Oh MC. , et al. Tuberculoma of the central nervous system. J Clin Neurosci 2013; 20 (10) 1333-1341
    CrossrefPubMedGoogle Scholar
  • 14 Heyderman RS, Morgan G, Levinsky RJ, Strobel S. Successful bone marrow transplantation and treatment of BCG infection in two patients with severe combined immunodeficiency. Eur J Pediatr 1991; 150 (07) 477-480
    CrossrefPubMedGoogle Scholar
  • 15 Ikincioğullari A, Doğu F, Ciftci E. , et al. An intensive approach to the treatment of disseminated BCG infection in a SCID patient. Bone Marrow Transplant 2002; 30 (01) 45-47
    CrossrefPubMedGoogle Scholar
  • 16 Aytekin C, Yuksek M, Dogu F. , et al. An unconditioned bone marrow transplantation in a child with purine nucleoside phosphorylase deficiency and its unique complication. Pediatr Transplant 2008; 12 (04) 479-482
    CrossrefPubMedGoogle Scholar
  • 17 McKenzie RH, Roux P. Disseminated BCG infection following bone marrow transplantation for X-linked severe combined immunodeficiency. Pediatr Dermatol 2000; 17 (03) 208-212
    CrossrefPubMedGoogle Scholar
  • 18 Bacalhau S, Freitas C, Valente R. , et al. Successful handling of disseminated BCG disease in a child with severe combined immunodeficiency. Case Rep Med 2011; 2011: 527569
    PubMedGoogle Scholar
  • 19 Jaing TH, Lee WI, Lin TY, Huang JL, Chen SH, Chow R. Successful unrelated mismatched cord blood transplantation in an infant with severe combined immunodeficiency and Mycobacterium bovis bacillus Calmette-Guèrin disease. Pediatr Transplant 2006; 10 (04) 501-504
    CrossrefPubMedGoogle Scholar
  • 20 Skinner R, Appleton AL, Sprott MS. , et al. Disseminated BCG infection in severe combined immunodeficiency presenting with severe anaemia and associated with gross hypersplenism after bone marrow transplantation. Bone Marrow Transplant 1996; 17 (05) 877-880
    PubMedGoogle Scholar
  • 21 Minegishi M, Tsuchiya S, Imaizumi M. , et al. Successful transplantation of soy bean agglutinin-fractionated, histoincompatible, maternal marrow in a patient with severe combined immunodeficiency and BCG infection. Eur J Pediatr 1985; 143 (04) 291-294
    CrossrefPubMedGoogle Scholar
  • 22 Amayiri N, Al-Zaben A, Ghatasheh L, Frangoul H, Hussein AA. Hematopoietic stem cell transplantation for children with primary immunodeficiency diseases: single center experience in Jordan. Pediatr Transplant 2013; 17 (04) 394-402
    CrossrefPubMedGoogle Scholar
  • 23 Beishuizen SJ, Geerlings SE. Immune reconstitution inflammatory syndrome: immunopathogenesis, risk factors, diagnosis, treatment and prevention. Neth J Med 2009; 67 (10) 327-331
    PubMedGoogle Scholar
  • 24 Searle E, Patel H, Vilar FJ. , et al. Inflammatory BCG adenitis associated with immune reconstitution following allogeneic haematopoietic stem cell transplant in infancy. Pediatr Blood Cancer 2010; 54 (01) 166-169
    CrossrefPubMedGoogle Scholar
  • 25 Puthanakit T, Oberdorfer P, Punjaisee S, Wannarit P, Sirisanthana T, Sirisanthana V. Immune reconstitution syndrome due to bacillus Calmette-Guérin after initiation of antiretroviral therapy in children with HIV infection. Clin Infect Dis 2005; 41 (07) 1049-1052
    CrossrefPubMedGoogle Scholar