Sternal osteitis after Bacillus Calmette-Guérin Vaccination: a case series

BACKGROUND: The Bacillus Calmette-Guérin (BCG) vaccine has been in use around the world for the prevention of tuberculosis since 1921. Unfortunately, this vaccine is associated with the risk of various complications. Post-BCG osteitis is one of the most serious complications. Our observations show that the sternum is the most common site.
AIM: The aim of the paper is to increase the medical community’s awareness and knowledge of such a rare but serious disease as post-BCG osteitis. This paper may be of interest to various specialists, as most patients do not seek primary medical care from a surgeon.
MATERIALS AND METHODS: In 2009–2023 in Surgery Department No. 2 of the Irkutsk regional children’s clinical hospital, 8 children with post-BCG sternal osteitis were treated, which is 29.63% of all cases of post-BCG osteitis of various sites. Six patients were male and two were female. The mean age of patients was 9.12 months (range: 5 to 14 months). Prior to surgical treatment, one child was diagnosed with a fistula that formed an extensive wound surface on the anterior chest wall. All children underwent multispiral computed tomography of the chest as the main preoperative diagnostic modality. As an additional diagnostic modality, ultrasound of the soft tissues overlying a tumor-like formation on the anterior surface of the chest wall was performed.
RESULTS: In 7 out of 8 cases, the diagnosis was based on a set of clinical and epidemiological criteria. Histology and cytology of surgical specimens were performed to confirm the diagnosis. In one case, the diagnosis was fully confirmed by molecular 
genetic methods. Radical necrectomy was the main surgical treatment option. Based on histological and cytological data, children with confirmed post-BCG osteitis were referred to a tuberculosis clinic for specific chemotherapy. The surgeon’s follow-up examinations showed no recurrence of the disease.
CONCLUSIONS: Post-BCG osteitis is one of the rarest and most serious complications of tuberculosis vaccination. Early radical surgery and specific treatment result in 100% complete recovery of children