809. Osteitis Caused by Bacillus Calmette-Guerin Tokyo 172 Strain in Immunocompetent Patients

BACKGROUND: Immunization with BCG vaccine has been associated with local and systemic complications. Osteitis secondary to Mycobacterium bovis-BCG is a rare complication with frequency of 0.1/100,000 doses. Below we report a series of a third level pediatric hospital in Mexico City. METHODS: This is a retrospective, descriptive, and observational study of subjects diagnosed with TB at the National Institute of Pediatrics (INP) in Mexico City during the 2010–2018 period. Subjects under 18 years with skeletal TB and positive culture for M. bovis-BCG strain were included. RESULTS: From 2010 to 2018, 118 cases of TB were treated, from which 3 (2.5%) were osteitis secondary to M. bovis-BCG Tokyo 172 strain, two male and one female. All three cases had BCG immunization at birth. The age at diagnosis was 1, 2, and 3 years, respectively. The most common symptoms were pain, edema, and limp. Sites of injury were right proximal tibia, epiphysis of left distal femur, and left ileopubic eminence. Lytic lesions with periosteal reaction were reported in plain radiographs of all cases. The TST and COMBE studies were negative. Diagnosis was confirmed by biopsy with identification of M. bovis-BCG Tokyo 172 strain by Genotype. All strains were sensitive to rifampicin. The treatment given was INH, RIF, E, PZA, and Clarithromycin during 2 months of intensive phase followed by 7 months of maintenance phase with INH-RIF. A surgical approach was performed with curettage and graft placement in two cases. Tetrazoil nitro blue tests and immunoglobulin levels were normal. Outcome was favorable in all three cases. CONCLUSION: In Mexico the BCG vaccine is part of the national immunization program and is applied to 99% of newborns. This work is the first report in Mexico of osteitis secondary to M. bovis-BCG strain Tokyo 172. We suggest considering the diagnosis in patients with osteitis under 5 years of age with a history of BCG vaccination. DISCLOSURES: All authors: No reported disclosures.