An 18-month-old girl, who had a normal birth history and an uneventful early neonatal period, received the BCG vaccine at birth on her left forearm as part of the routine vaccination schedule. There was no history of contact with tuberculosis. At the age of 2 months, she developed a swelling at the BCG site which was tender but there was no discharge; a few weeks later her whole left arm became swollen with reduced movement. There were no lymph nodes enlargements. She was seen at a surgery where an abscess was drained and she was prescribed antibiotics. She continued to be febrile and developed discharging sinus at the site of the wound.
Examination
Further radiological assessment of her left wrist joint showed a well-defined metaphyseal lytic lesion with partially sclerotic margin and narrow zone of transition not crossing the physis, and soft tissue opacity was noted indicating soft tissue component. Her complete blood count was normal, erythrocyte sedimentation rate (ESR) was 5 mm/hour, and her C-reactive protein (CRP) was negative. A chest X-ray (CXR) was also normal.
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