Pediatrics international : official journal of the Japan Pediatric Society
BCG Scar Reactivation (BCGitis) in Kawasaki Disease: A Scoping Literature Review
By Khreis D, Sulaiman A, Abusalah Y and 4 others.
Abstract
Background
Bacillus Calmette-Guérin (BCG) scar reactivation (BCGitis) is a distinctive clinical sign reported in Kawasaki disease (KD), yet evidence remains scarce across the literature. We aimed to summarize the epidemiology, chronology, clinical correlates, and coronary outcomes associated with BCGitis in KD.
Methods
We conducted a PRISMA-ScR-guided scoping review of studies describing BCGitis in KD. Data were synthesized descriptively across retrospective cohorts and case reports/series.
Results
Forty studies published between 1997 and 2024 were included (10 retrospective cohorts; 30 reports of 36 cases). BCGitis was most frequently described in infants and young children (< 2 years, often < 6-12 months) and was commonly associated with earlier recognition and treatment. Reported BCGitis prevalence varied across cohorts, from 11.8% to 49.9%. Coronary artery lesions (CAL) and IVIG resistance were reported at lower rates in some cohorts; however, these findings were not statistically significant. In the case reports, most patients were infants, male predominance was observed, and incomplete KD was frequent. BCGitis was often reported during the early febrile phase, sometimes preceding complete KD diagnostic criteria. Most reported cases responded to IVIG. Coronary abnormalities were usually mild or transient, although two giant aneurysms, one case of Kawasaki disease shock syndrome, and one mortality were reported.