Case Study: BCG Vaccine-Induced Tuberculosis Takes Life of a 4-Month-Old Boy with Wiskott-Aldrich Syndrome

Summary

BCG vaccination is believed to give some protection against tuberculosis, and for this reason, the Universal Immunization Program includes this vaccine. However, recently I had a very sad experience while dealing with a case of disseminated tuberculosis; better to say that the little baby’s body was just converted into packets full of AFB! In the course of investigation, we found that the 4-month-old boy was just a case of primary immunodeficiency, and he passed away 2 months after diagnosis. I think immunologists and immunization programmers could be more helpful in such cases!

Introduction

Wiskott-Aldrich syndrome is an X-linked recessive disorder which is characterized by thrombocytopenia with small platelets, eczema, recurrent infections and predisposition to autoimmune diseases and malignancy. It is a rare disorder of the immune system. It occurs in approximately 4 out of every 1 million live male births, but there is no clear racial or ethnic correlation. The purpose of this case report is to describe the spectacular inhabitation of a baby’s body by Acid-Fast Bacilli (AFB) and eventually his death, within 2 months of diagnosis. The boy was a case of Wiskott-Aldrich syndrome that we suspected, and he was diagnosed only after he had a very heavy disease.

Case Presentation and Investigations

A 4-month-old male child presented with generalized eczema, purpuric spots on pressure points, recurrent upper- and lower-respiratory tract infections, occasional bloody diarrhea, poor weight gain / malnutrition, fever and huge axillary swelling (lymphadenopathy) of 5 cm in diameter. He was given the BCG immunization vaccine on the first day of his life. His one female sibling, aged 4 years, was normal. Investigations revealed low serum IgG and IgM levels, and raised IgE and IgA levels with neutrophilia, thrombocytopenia and raised ESR. Chest X-ray was suggestive of pneumonitis but no hilar lymphadenopathy was found. Platelet count was 30 to 40 thousand per micro liter (low) with predominantly microplatelets. ...

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