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Necrotic Tuberculin Skin (Mantoux) Test ReactionNecrotic Tuberculin Skin Test Case: A Case Report and an Estimation of Frequency

Dim Bunnet, MD; Alexandra Kerleguer, MD; Peou Kim, MD; Polidy Pean, MD, PhD; Viseth Phuong, MD; Nayyim Heng, MD; Yiksing Peng, MD; Laurence Borand, PharmD, PhD; Arnaud Tarantola, MD
Author and Funding Information

From the Epidemiology and Public Health Unit (Drs Bunnet, Phuong, Heng, Peng, Borand, and Tarantola), International Vaccination Center (Drs Phuong, Heng, Peng, and Tarantola), the Clinical Laboratory (Dr Kerleguer), and the Immunology Unit (Dr Pean), Institut Pasteur du Cambodge; and the National Pediatric Hospital (Dr Kim), Phnom Penh, Cambodia.

CORRESPONDENCE TO: Arnaud Tarantola, MD, Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, 5, Blvd Monivong, BP 983 - Phnom Penh, Cambodia; e-mail: atarantola@pasteur-kh.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(1):e1-e4. doi:10.1378/chest.14-2463
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Tuberculin skin testing was performed on a 5-year-old girl in Phnom Penh, Cambodia. She had been immunized by Bacille de Calmette et Guérin. She was tested because of a palpable cervical node and a slightly elevated temperature. Within 48 h, a deep necrotic lesion appeared on the volar aspect of the left arm. The lesion was treated locally, and the child was not treated for suspected TB. To our knowledge, this is the first instance of necrosis in 11,392 people who received Tubersol doses since 1996 to date at our International Vaccination Center, for an estimated incidence of 0.18 per 1,000 (95% Poisson 0.04-0.70 per 1,000 doses used). At a follow-up consultation after 77 days, the lesion had scarred and the child showed no signs suggestive of active TB. Although latent TB infection remains the most likely diagnosis, other types of mycobacterial infection may be considered in the tropical setting and in the absence of signs suggestive of active TB.

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