Retroperitoneal Abscess in Severe Combined Immunodeficiency Probably Due to BCG Vaccine

Severe combined immunodeficiency (SCID) is characterized by the impairment of T cells with or without B and Natural Killer (NK) cells, leading to recurrent bacterial and viral infections. Although hematopoietic stem cell transplantation (HSCT) is the curative treatment of SCID, many complications and especially infections can develop afterwards. Herein, we report a seven-month-old girl who was diagnosed with SCID and underwent HSCT from HLA-full-matched related donor. However, the patient was complicated with retroperitoneal abscess and chest wall granuloma following HSCT, probably due to the Bacillus Calmette Guerin (BCG) vaccine. The symptoms of the patient were controlled with anti-tuberculosis therapy and intravenous antibiotics.


1. Le Deist F, Moshous D, Howe SJ, Nahum A, Kavadas FD, Lavine E, et al. Combined T-and B-Cell immunodeficiencies. In: Rezaei N, Aghamohammadi A, Notarangelo LD (eds). Primary Immunodeficiency Disorders. 1st ed. Heidelberg: SpringerVerlag, Berlin, 2008: 39-95.

2. Marciano BE, Huang C-Y, Joshi G, Rezaei N, Carvalho BC, Allwood Z, et al. BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies. J Allergy Clin Immunol 2014;133:1134-41.

3. Aytekin C, Yuksek M, Dogu F, Yagmurlu A, Yildiran A, Fitoz S, et al. An unconditioned bone marrow transplantation in a child with purine nucleoside phosphorylase deficiency and its unique complication. Pediatr Transplant 2008;12:479-82.

4. Alborzi A, Mostafavi N. Retroperitoneal abscess due to disseminated Bacille Calmette-Guerin infection. Jpn J Infect Dis 2007;60:392-3.

5. Kroger AT, Atkinson WL, Marcuse EK, Pickering LK. General recommendations on immunization; recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 2006;55:1-48.

6. Lotte A. Second IUATLD study on complications induced by intradermal BCG-vaccination. Bulletin of the International Union Against Tuberculosis and Lung Disease 1988;63:47-59.

7. Hengster P, Sölder B, Fille M, Menardi G. Surgical treatment of bacillus Calmette Guerin lymphadenitis. World J Surg 1997;21:520-3.

8. Hesseling A, Rabie H, Marais B, Manders M, Lips M, Schaaf H, et al. Bacille Calmette-Guérin vaccine—induced disease in HIV-infected and HIV-uninfected children. Clin Infect Dis 2006;42:548-58.

9. Norouzi S, Aghamohammadi A, Mamishi S, Rosenzweig SD, Rezaei N. Bacillus Calmette-Guérin (BCG) complications associated with primary immunodeficiency diseases. J Infection 2012;64:543-54.

10. İkincioğulları A, Doğu F, Ciftci E, Ünal E, Ertem M, Reisli I, et al. An intensive approach to the treatment of disseminated BCG infection in a SCID patient. Bone Marrow Transplant 2002;30:45-7.

11. Seggewiss R, Einsele H. Immune reconstitution after allogeneic transplantation and expanding options for immunomodulation: An update. Blood 2010;115:3861-8.

12. Bernatowska E, Wolska-Kuśnierz B, Pac M, Kurenko-Deptuch M, Pietrucha B, Zwolska Z, et al. Clinical guidelines risk of BCG infection in primary immunodeficiency children. Proposal of diagnostic, prophylactic and therapeutic guidelines for disseminated BCG based on experience in the Department of Immunology, Children’s Memorial Health Institute in Warsaw between 1980-2006. Cent Eur J Immunol 2007;32:221-5.

13. Nachega JB, Chaisson RE. Tuberculosis drug resistance: A global threat. Clin Infect Dis 2003;36(Supplement 1):S24-S30.

14. Tasdan Y, Alikasifoglu M, Midilli K, Ilter Ö. Chest wall abscess as an unusual presentation of childhood tuberculosis. Pediatr Infect Dis J 1998;17:85-6.

15. Kim D, Choi C. Chest wall abscess likely due to BCG vaccination in a child. Infection 2009;37:286-8.

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