Doença disseminada por Mycobacterium bovis vacinal em paciente pediátrica com infecção pelo HIV: um relato de caso

Abstract

Introduction: The Bacillus Calmette–Guérin (BCG) vaccine, composed of attenuated strains of Mycobacterium bovis (M. bovis), is widely used in Brazil to prevent severe forms of tuberculosis in childhood. Although it has a favorable safety profile, BCG vaccination may cause complications in immunocompromised individuals, particularly in children living with Human Immunodeficiency Virus (HIV), in whom the risk of disseminated BCG disease (BCGosis) is significantly increased, being associated with high morbidity and mortality and substantial diagnostic challenges. Objective: To describe the case of a pediatric patient with vertically acquired HIV infection and a delayed diagnosis, who developed disseminated BCG disease following neonatal vaccination. Case description: A female infant with a history of neonatal BCG vaccination presented with persistent infectious manifestations and signs of multisystem involvement and was subsequently diagnosed with vertically acquired HIV infection. Prior to confirmation of disseminated BCG disease, the patient underwent multiple antituberculosis treatment regimens, contributing to a delay in appropriate therapy. Diagnostic investigation revealed isolation of the Mycobacterium tuberculosis complex, consistent with disseminated BCG disease in the context of immunodeficiency. Specific antimycobacterial therapy was initiated in association with antiretroviral treatment, with follow-up in a specialized outpatient clinic. Discussion: This case illustrates a rare and potentially fatal complication of BCG vaccination in an immunocompromised child, emphasizing the importance of early HIV diagnosis in exposed infants and highlighting the diagnostic challenges of disseminated BCG disease, as well as the risks associated with BCG vaccination in vulnerable pediatric populations.