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Question

I have recently seen a 4/12 old female infant who received a BCG vaccination in the Left lateral thigh in dec. She subsequently developed an abscess that pointed and drained 3months later. She was initially seen by a colleague who prescribed Cefaclor post abscess rupture (no swab sent for culture). The abscess has healed somewhat but there still exists a small 1.5cm area that is firm and nonadherent to underlying muscle however, there is a small erythematous, fluctuant area at site of previous I&D (like a small hematoma). I also performed a small I&D but just blood, no pus was expelled. A swab culture was sent but returned negative for bacteria/AFB. The child is otherwise well and playful with no other lypmadenopathy. Obs are normal. Xray of the left femur is normal and ultrasound showed just a dermal lesion. The mother is worried about the persistence of this problem. Is there any other treatment to be performed or is just patience required(and the lesion will evenutally heal)? I have performed an internet search and there is very little hepful information regarding treatment of this problem.

Answer

First and foremost it is difficult to comprehend why BCG was given over the thigh? Also one needs to determine whether it was given intradermal or subcut? If given subcutaneously, then one would consider giving her 3-6 months of INH as she has skin erythematous area.
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