Bacillus Calmette-Guerin-Associated Cervical Spondylitis in
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Bacillus Calmette-Guerin (BCG)–associated osteomyelitis is a rare adverse event following BCG vaccination, and there have been no previous reports of BCG-associated cervical spondylitis.

A 3-year-old girl with a cervical spine lesion was referred for further examination and treatment. She had complained of a sore throat for 10 days prior, had reduced vitality since the day before referral and tended to lie down. She had received the BCG vaccine by percutaneous administration to her left deltoid muscle with a multipuncture device at 5 months of age.

On physical examination at admission, her body temperature was 36.6°C and SpO2 was 99% (room air). Although she could walk, she was listless and was unwilling to walk on her own. She did not complain of neck pain. The Babinski reflex was positive only on the left side. Her other neurologic findings were unremarkable and her deep tendon reflexes of the upper and lower extremities were normal.

Cervical radiograph at admission showed C4 vertebral bony destruction and malalignment. Additional cervical computed tomography indicated that the C4 vertebral body was crushed with osteolytic change and was protruding to the spinal canal side. A mass with a contrast effect on the rear of the vertebral body was pressing on the cervical spinal cord. T2-weighted MRI on the third hospital day revealed a mass lesion with a contrast effect in front of the C4 vertebra.

On the day of admission, her neck was fixed with a Philadelphia-type brace, and the following day, cervical vertebral extracorporeal fusion (hello vest attachment) was performed. A cervical spine mass biopsy was performed on the third hospital day urgently due to the appearance of bladder/bowel dysfunction. Intraoperative findings revealed no solid components, and abscess was punctured and drained. Intraoperative rapid pathologic examination revealed only inflammatory cells and no malignant findings; therefore, the patient underwent curettage and decompression at the C4 level. (PCR) of the biopsy specimen was positive for Mycobacterium tuberculosis complex. After 4 weeks of culture, the isolate was confirmed as the M. bovis BCG on multiplex polymerase chain reaction (PCR) analysis.

Based on the results of PCR, she was started on INH (10?mg/kg/day) and RFP (10?mg/kg/day) on the fourth day of hospitalization. Furthermore, a bone transplant was performed on the collapsed C4 vertebra. The curetted vertebral body was replaced with a left fibular graft with an anterior approach on the 14th day of hospitalization. However, because the bone graft had been displaced, she was refixed on the 22nd day of hospitalization.

Over a period of 3 months, she was gradually released from rest by hospitalization management. After confirming that there was no displacement of the transplanted bone, she underwent halo vest removal on the 101st day and was discharged on the 115th day of hospitalization. The patient was treated with INH and RFP for a total of 9 months. Nine months after the operation, the cervical lateral radiograph showed cervical vertebral fusion. At the time of writing this report, it is 1 year after onset, and neither sequelae nor recurrence of symptoms has been observed.

The BCG vaccine remains useful, but physicians should be aware that this vaccine can also cause cervical spondylitis and should initiate prompt investigation and treatment if there are suspicious symptoms or findings.

Source: https://journals.lww.com/pidj/Fulltext/2020/12000/Bacillus_Calmette_Gu_rin_Associated_Cervical.37.aspx
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