Two infants with tuberculid associated with Kawasaki disease

Bacille de Calmette et Guerin (BCG) is the only licensed tuberculosis vaccine to prevent severe tuberculosis. The adverse events of BCG vaccination, including local reactions, lymphadenitis, osteomyelitis, tuberculid, and disseminated infection, have been reported. Two infants presented erythema at the inoculation site of BCG after the resolution of Kawasaki disease (KD). They received BCG vaccination 1 week and 6 weeks before the KD onset, respectively. Intravenous immunoglobulin improved the KD activity, however the skin rash of BCG inoculation site extended to the face and extremities days 24 and 10 after the KD onset, respectively. Both bacteriological study and interferon-γ release assay were negative for Mycobacterium tuberculosis infection. These patients were diagnosed as having tuberculid after KD. The skin lesions gradually disappeared without antibiotic therapy over 2 months. The development of tuberculid in these patients might be associated with the remnant immune activation of KD.