WM Chan, YW Kwan, CW Leung

Abstract

Bacillus Calmette-Guéin (BCG) related regional lymphadenitis is not an uncommon complication following BCG vaccination. We present a case series of 11 infants with suppurative BCG lymphadenitis managed in Hospital Authority Infectious Disease Centre of Hong Kong over a 5-year period. All of them presented with isolated left axillary mass which suppurated at a mean of 3.5 months (range 2 to 5 months) after BCG vaccination. The diagnosis of the condition is basically clinical. Five infants who were initially managed with needle aspiration alone showed significant regression in the sizes of their enlarged lymph nodes and surgical excision was spared. Surgical incision and drainage was performed in 5 other infants prior to referral to our centre. They all developed significant irregular scarring and 2 eventually developed keloids over their scars upon healing. We recommend that suppurative BCG lymphadenitis should be managed initially by needle aspiration. Total excision should be considered if aspiration fails or suppuration recurs despite repeated needle aspiration. Incision and drainage is mentioned to be condemned.

卡介苗（BCG）相關的局部淋巴腺炎在BCG接種後並不罕見。我們闡述過去五年間醫院管理局香港傳染病中心處理過的11個BCG化膿性淋巴腺炎嬰兒病例。他們都在接種BCG後，平均3.5月（範圍：2-5月）出現單獨左腋下化膿性結節。根據臨床情況作出診斷。當中五名嬰兒只接受穿刺抽吸作初步處理，結果腫大的淋巴結明顯縮小和免去外科切除。另外當中有5名嬰兒在轉介到本中心前，接受了外科切開和引流手術。他們都出現明顯的不規則結疤，其中兩人最終發展成瘢痕。我們建議BCG化膿性淋巴腺炎應使用穿刺作初步處理。若穿刺無效或儘管重複穿刺仍出現復發化膿，則應該考慮全切除手術。切開術和引流都皆不應被採用。