Inflammation in the scar caused by BCG vaccination years previously: a case report, systematic review and critical appraisal [version 1; peer review; awaiting peer review]
File(s)
Author(s)
Athanasiou, Veatriki
Datta, Sumona
Evans, Carlton
Type
Journal Article
Abstract
Background:
Live Bacillus Calmette-Guérin (BCG) mycobacteria are in most countries injected into the skin of the shoulder of newborn babies as a vaccine to prevent or reduce the severity of tuberculosis disease. Also, since 1976, patients with bladder cancer are often treated with BCG instillations into their bladder as intravesical immunotherapy that reduces the risk of bladder cancer recurrence. We encountered a previously healthy 72-year-old man who noticed blood in his urine, which led to the diagnosis of bladder cancer. After endoscopic removal of the bladder cancer, he commenced outpatient immunotherapy with BCG instillations into his bladder. Approximately one month later, the scar on his shoulder at the site of his childhood BCG vaccination became red and swollen with a serous secretion. This local skin reaction fluctuated, increasing after each BCG instillation into his bladder, and eventually resolved spontaneously without medical intervention. The bladder cancer was cured, without recurrence during 14-years follow-up. Thus, a scar on his shoulder from childhood BCG vaccination more than 70 years previously became inflamed as an adverse reaction to BCG instillation into his bladder.
Methods:
The relevant published literature was systematically reviewed and critically appraised.
Findings:
Our systematic review of the literature concerning BCG scar inflammation did not reveal any similar reports, although anecdotally, we found that other patients have had similar experiences. We identified diverse evidence that years after BCG vaccination, antigens and/or mycobacteria remain immunologically active in BCG vaccination scars. Furthermore, mRNA COVID-19 vaccination, Kawasaki disease, acute lymphoblastic leukaemia, and immunosuppressive therapy with TNF inhibitors have all caused adults to develop inflammation in their BCG scar years or decades after childhood BCG vaccination.
Conclusions:
Our systematic review, associated findings and critical appraisal demonstrate the persistence of immunologically relevant BCG mycobacteria and/or mycobacterial antigens at the site of BCG vaccination for decades after vaccination.
Live Bacillus Calmette-Guérin (BCG) mycobacteria are in most countries injected into the skin of the shoulder of newborn babies as a vaccine to prevent or reduce the severity of tuberculosis disease. Also, since 1976, patients with bladder cancer are often treated with BCG instillations into their bladder as intravesical immunotherapy that reduces the risk of bladder cancer recurrence. We encountered a previously healthy 72-year-old man who noticed blood in his urine, which led to the diagnosis of bladder cancer. After endoscopic removal of the bladder cancer, he commenced outpatient immunotherapy with BCG instillations into his bladder. Approximately one month later, the scar on his shoulder at the site of his childhood BCG vaccination became red and swollen with a serous secretion. This local skin reaction fluctuated, increasing after each BCG instillation into his bladder, and eventually resolved spontaneously without medical intervention. The bladder cancer was cured, without recurrence during 14-years follow-up. Thus, a scar on his shoulder from childhood BCG vaccination more than 70 years previously became inflamed as an adverse reaction to BCG instillation into his bladder.
Methods:
The relevant published literature was systematically reviewed and critically appraised.
Findings:
Our systematic review of the literature concerning BCG scar inflammation did not reveal any similar reports, although anecdotally, we found that other patients have had similar experiences. We identified diverse evidence that years after BCG vaccination, antigens and/or mycobacteria remain immunologically active in BCG vaccination scars. Furthermore, mRNA COVID-19 vaccination, Kawasaki disease, acute lymphoblastic leukaemia, and immunosuppressive therapy with TNF inhibitors have all caused adults to develop inflammation in their BCG scar years or decades after childhood BCG vaccination.
Conclusions:
Our systematic review, associated findings and critical appraisal demonstrate the persistence of immunologically relevant BCG mycobacteria and/or mycobacterial antigens at the site of BCG vaccination for decades after vaccination.
Date Issued
2025-09-26
Date Acceptance
2025-09-26
Citation
Wellcome Open Research, 2025, 10
ISSN
2398-502X
Publisher
Wellcome
Journal / Book Title
Wellcome Open Research
Volume
10
Copyright Statement
© 2025 Athanasiou V et al. This is an open access work distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.12688/wellcomeopenres.18587.1
Publication Status
Published
Article Number
527
Date Publish Online
2025-09-26