571. Successful treatment of disseminated Bacillus Calmette-Guérin disease in an HIV-infected child using a linezolid-containing regimen
Session: Poster Abstract Session: Non-Tuberculosis Mycobacterial
Thursday, October 27, 2016
Room: Poster Hall
Posters
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  • Background: Disseminated Bacillus Calmette-Guerin (BCG) infection is a rare complication of BCG vaccination that occurs almost exclusively in immunocompromised children.

    Methods: We report a case of disseminated M. bovis infection in an HIV-infected child following BCG vaccination, which eventually required treatment with isoniazid, ethambutol, rifabutin and linezolid.

    Results: An HIV-infected 8-month-old boy was transferred for evaluation of worsening respiratory distress requiring mechanical ventilation. Pneumocysits jirovecii pneumonia (PCP) was diagnosed; he also had a non-healing ulcer at the site of vaccination with Statens Serum Institut (Danish strain) BCG and associated axial lymphadenopathy. PCP treatment resulted in weaning from mechanical ventilation. Antimycobacterial treatment was immediately attempted but was discontinued because of hepatotoxicity. Over several months, he developed splenic lesions, then disseminated skin and cystic bone lesions. M. bovis was repeatedly cultured both from skin and bone lesions despite eight months of various multi-drug antimycobacterial regimens which included linezolid (Figure). Treatment with a final regimen of isoniazid, ethambutol, rifabutin and linezolid resulted in a negative lymph node aspirate culture within 4 months. An additional 12 months of treatment led to definitive cure. While our patient improved clinically after linezolid was added to the treatment regimen, he still had intermittent fever and developed new lytic bone lesions. The addition of rifabutin to the antimycobacterial regimen eventually resulted in complete cure.

    Conclusion: Clinicians should consider a regimen containing linezolid for treatment of severe disseminated BCG infection, especially if other drug regimens have failed. Although drug toxicity is a particular concern for young children, linezolid was used in this patient for 13 months without serious toxicity. This case also highlights the need for universal screening among pregnant women to prevent vertical transmission of HIV. Finally, routine immunization with BCG at birth should be questioned in countries with low and declining burdens of tuberculosis.

    Srđan Roglić, MD1, Drusia Dickson, Medical student2, Branko Miše, MD1, Klaudija Višković, MD PhD1, Vera Katalinic Janković, MD3, George Rutherford, MD MPH4 and Josip Begovac, MD PhD1,5, (1)University Hospital for Infectious Diseases Dr. Fran Mihaljevic, Zagreb, Croatia, (2)University of California, San Francisco, San Francisco, CA, (3)National Institute of Public Health, Zagreb, Croatia, (4)Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, (5)University of Zagreb, School of Medicine, Zagreb, Croatia

    Disclosures:

    S. Roglić, None

    D. Dickson, None

    B. Miše, None

    K. Višković, None

    V. Katalinic Janković, None

    G. Rutherford, None

    J. Begovac, None

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