BCG vaccine is given to a neonate. At 6 weeks, the injection site shows a papule that progresses to a pustule. Regional (left axillary) lymph nodes are enlarged to 1.5 cm, non-fluctuant, and the skin overlying them is normal. The infant is thriving and afebrile. This represents:

• A BCG disease requiring isoniazid therapy
• B BCG lymphadenitis requiring needle aspiration
• C BCG sepsis in an immunocompromised child; investigate for SCID
• D Normal BCG reaction; no intervention needed ✓

Explanation

The described progression — papule → pustule → scar over 6–12 weeks at the BCG injection site with regional lymphadenopathy up to 1–2 cm — is a normal BCG reaction and indicates successful immunisation. Non-fluctuant, non-tender, moderate lymphadenopathy without skin changes or systemic features requires no treatment. BCG lymphadenitis (a complication) implies nodes >3 cm, fluctuance, or skin involvement and may require aspiration. BCG sepsis/dissemination occurs only in severe immunodeficiency and would present with systemic illness.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.