# Bacillus Calmette Guérin Osteomyelitis of the Proximal Tibia Extending to the Physis and Epiphysis in an Immunocompetent Toddler: A Case Report

## TL;DR

A 22-month-old child developed a rare BCG vaccine complication in the tibia, requiring complete surgical removal to prevent long-term bone growth issues.

## Contribution

Highlights the necessity of complete curettage in BCG osteomyelitis involving the physis and epiphysis to prevent orthopedic complications.

## Key findings

- Minimal curettage combined with anti-tuberculosis drugs was insufficient for treating BCG osteomyelitis in this case.
- Complete curettage of the lesions prevented disruption in bone growth during 32 months of follow-up.
- Timely and sufficient surgical intervention is critical for managing BCG osteomyelitis involving the physis and epiphysis.

## Abstract

Bacillus Calmette-Guérin (BCG) osteomyelitis is a very rare but serious complication of BCG immunization. Although most affected patients experience a good outcome, late orthopedic complications, such as discrepancy in leg length, are a concern. The impact of the extent of surgical intervention on minimizing orthopedic complications remains unclear, especially in patients with BCG osteomyelitis involving the physis. Here, we report the case of a 22-month-old immunocompetent boy who developed BCG osteomyelitis in the proximal metaphysis of the right tibia, which extended to the physis and epiphysis and was accompanied by a large subcutaneous abscess. In the current case, minimal curettage with anti-tuberculosis drugs, which can prevent damage to the physis and epiphysis, was not beneficial. Hence, complete curettage of the lesions was required. No disruption in bone growth was observed at the last follow-up evaluation performed 32 months after the first visit. Based on our experience, timely and sufficient curettage is essential to control the disease and prevent orthopedic complications in patients with BCG osteomyelitis involving the physis and epiphysis.