Adult case of chronic granulomatous disease with left axillary lymphadenitis caused by Mycobacterium tuberculosis var. BCG over 40 years post-vaccination: A case report

Chronic granulomatous disease (CGD) is an inherited phagocytic dysfunction disorder. Bacillus Calmette-Guérin (BCG) vaccination is contraindicated in patients with CGD, given the risk of BCG-related infections. Notably, adverse reactions post-BCG vaccination in patients with CGD are commonly observed in childhood. In the present report, we describe the case of an adult Japanese man with CGD who developed left axillary BCG lymphadenitis at 42 years of age. The patient received the BCG vaccine at 3 months old and did not develop any childhood BCG-related disease. However, at 38 years of age, he developed a swollen left axillary lymph node. At 42 years of age, a lymph node biopsy was performed, and Mycobacterium tuberculosis var. BCG was subsequently identified. The patient was accordingly treated with antimicrobial agents for two years. Following the completion of the antimicrobial therapy, prophylaxis with interferon-gamma (IFN-γ) was administered intermittently; despite this, lymphadenitis did not relapse. This report highlights that BCG-related complications should be considered in immunocompromised patients with BCG vaccination history, even many years post-vaccination.