Forum for Nordic Dermato-Venereology No 3, 2019 Telemedicine | Page 18

Case Report Lymphadenitis in a Greenlandic Inuit Boy after Bacillus Calmette-Guérin Vaccination L uit P enninga 1 , A nne K athrine L orentzen 1 M ikkelsen 2 and C arsten S auer Ilulissat Hospital, Ilulissat, Avannaa Region, Postbox 514, 3952 Ilulissat, Greenland, 2 Research Lab, Department of Dermatology, University of Aalborg, and Private Dermatology Practice, Brønderslev, Denmark. E-mail: [email protected] 1 As Greenland has an exceedingly high incidence of tuber- culosis, the Bacillus Calmette-Guérin (BCG) vaccination is a part of the childhood immunization programme (1, 2). Severe complications to the BCG vaccination are very rare. One of the most well-known complications associated with BCG vaccination is lymphadenitis, which can usually be treated without sequelae (3). We report here a Greenlandic Inuit boy who developed non-suppurative lymphadenitis and was treated conservatively with good results. C ase R eport A Greenlandic Inuit boy was born at term after an uncompli- cated pregnancy and normal vaginal delivery. Intracutaneous BCG vaccination was given in the left upper arm. He was discharged from the regional hospital and went home to the rural village in which the family lived. A few weeks later, the mother observed a swelling in the left armpit and contacted the hospital. A large swelling in the left axilla was found (Fig. 1). The swelling was painless, smooth, firm, and not fixed to the underlying tissue. There was no erythema or other cuta- neous changes. The BCG inoculation site was without signs of infection (Fig. 2.) The child was thriving and gaining weight and did not show any signs of systemic affection. An ultra- sound of the swelling did not detect any fluid. Neither biopsy nor excision was performed. After 3–4 months, the swelling decreased in size, and after 6 months it had disappeared. Fig. 2. No signs of infection were seen at the site of Bacillus Cal- mette-Guérin injection. D iscussion In the 1950s, the population of Greenland had the highest rate of tuberculosis worldwide (1). Hence, a nationwide neo- nate vaccination programme with the BCG vaccination was introduced in 1955. In 1989, this intervention was phased out as tuberculosis was basically extinct in Greenland, and the vaccination programme ended in 1991 (1). From 1991 to 1997 the incidence of tuberculosis doubled and the vaccination programme was reinitiated (2). Children born between 1991 and 1997 were offered vaccination, but many failed to receive the offer or did not accept the vaccination (2). Therefore, there is a higher incidence of tuberculosis in people born between 1991 and 1997 compared to the rest of the population, and men are more often affected than women (2). However, the incidence of tuberculosis in Greenland is de- clining due to better surveillance, management, and infection control. Tuberculosis is still endemic, and the BCG vaccination continues to be a part of the immunization programme in Greenland (2). Fig. 1. Severe lymphadenitis of the axilla after Bacillus Calmette-Guérin vaccination of the ipsilateral arm. 102 In this case report, we describe a rare complication to the BCG vaccination (3). Lymphadenitis occurs in 3/1,000 children who receive the vaccination (4). Lymphadenitis often occurs at the ipsilateral arm of the vaccination site (5). Normally, there are no signs of infection, and the patient has no fever. The lymphadenitis is characterized by isolated axillary, su- Forum for Nord Derm Ven 2019, Vol. 24, No. 3