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July 4, 1977

Failure of Isoniazid to Cure Localized BCG Infection

Author Affiliations

From the Departments of Medicine (Drs Lorber and Swenson), Dermatology (Dr Vonderheid), and Microbiology-Immunology (Drs Cundy, Lorber, and Swenson), Temple University Health Sciences Center, Philadelphia.

JAMA. 1977;238(1):55. doi:10.1001/jama.1977.03280010055023

INFECTIOUS complications of BCG vaccination and immunotherapy have been rare, even in immunosuppressed patients who have responded readily to two to four months of isoniazid therapy.1,2 We report a case in which accidental BCG inoculation led to a localized hand infection that failed to respond to three months of isoniazid therapy.

Report of a Case  On Sept 10, 1975, a physician engaged in laboratory research accidentally inoculated the dorsum of her right index finger over the distal interphalangeal joint with BCG diluted in saline. It is estimated that she received a maximum of 12 × 107 colonyforming units. Over the next two days the finger became painful and swollen, and two weeks later an ulcerative lesion developed at the injection site. A smear of the lesion showed acid-fast bacilli, and cultures grew an organism subsequently identified as BCG. After three months of isoniazid treatment (300 mg/day), there was