COMMON CHEST AND ABDOMINAL COMPUTED TOMOGRAPHY FINDINGS AMONG PATIENTS WITH DISSEMINATED BCG DISEASE
Shahram Kahkouee1, Seyed Alireza Mahdaviani2, Dina Jalalvand3 and Brandon S Shaw4
Keywords:Computerized tomography, Infection, Public Health, Primary immunodeficiency
The Bacillus Calmette-Guerin (BCG) vaccine, given to prevent Mycobacterium tuberculosis, may cause disseminated BCG, an infection and inflammatory reaction in immunocompromised individuals. In this study, we aimed to determine the chest and abdominal computed tomography (CT) findings among patients with disseminated BCG disease in order to identify some potential consequences of this vaccine and their frequencies. This study was conducted among all patients aged <16 years admitted to Masih Daneshvari Hospital, Tehran, Iran, during 2016-2019 who received the BCG vaccine and had disseminated BCG disease. Disseminated BCG disease was defined as having miliary pulmonary nodules or lymphadenitis or an abscess or fistula at the BCG vaccination site and >2 of the following: a temperature >38.5°C for >2 weeks, a familial history of immunodeficiency, weight loss, recurrent or persistent diarrhea, recurrent or persistent oral candidiasis, body aches, a hemoglobin <10 mg/dl or hepato- or splenomegaly. Exclusion criterion for study subjects were having a history of a lung disease unrelated to disseminated BCG disease or a diagnosis of tuberculosis or other atypical mycobacterial infections. Chest and abdominal CT scans were performed within 48 hours of admission on each study subject. A total of 22 subjects were included in the study; 14 males. The mean (+standard deviation) age of study subjects was 68 (+51) (range: 3-192) months. The chest and abdominal CT scan results among study subjects revealed: 55% (n=12) had a mediastinal mass, 36% (n=8) had a lung parenchymal mass, 36% (n=8) had a fusion of lung and mediastinal tissue, 36% (n=8) had invasion of the mediastinum, 32% (n=7) had lung parenchyma collapse, 27% (n=6) had invasion of the chest wall, 18% (n=4) had invasion of the ribs, 9% (n=2) had lobulated soft tissue lesions and 9% (n=2) had a cutaneous tract. In summary, we identified the most common chest and abdominal CT findings among subjects with disseminated BCG disease. We conclude that due to the not uncommon problem of immunocompromised patients in the study population and relatively common problem of disseminated BCG disease, these CT results should be considered as possible manifestations of disseminated BCG disease. Further studies are needed to determine if any of these chest and abdominal CT findings can be used for the early diagnosis of disseminated BCG disease.