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Volume 10
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Case Report

Unmasking Bacillus Calmette–Guérin Immune Reconstitution Inflammatory Syndrome in a Perinatal HIV Transmission—A Case Report

by
Daniel Ivanov
1,2,*,
Dimitar Strashimirov
1,2,
Rusina Grozdeva
1,2,
Evgeni Penchev
2,
Elena Georgieva
3 and
Nina Yancheva
1,2
1
Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University–Sofia, 1431 Sofia, Bulgaria
2
Department of AIDS, University Hospital for Infectious and Parasitic Diseases “Prof. Ivan Kirov”– Sofia, 1431 Sofia, Bulgaria
3
Clinic of Pediatric Pneumology and Phthisiology, University Hospital “St. Ivan Rilski”, 1431 Sofia, Bulgaria
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2025, 10(6), 148; https://doi.org/10.3390/tropicalmed10060148
Submission received: 29 March 2025 / Revised: 20 May 2025 / Accepted: 22 May 2025 / Published: 23 May 2025
(This article belongs to the Special Issue HIV Testing and Antiretroviral Therapy)
Versions Notes

Abstract

Bacillus Calmette–Guérin (BCG)-related immune reconstitution inflammatory syndrome (IRIS) is a recognised complication following antiretroviral therapy (ART) initiation in HIV-infected infants. We report the case of a 19-month-old child with undiagnosed perinatally acquired HIV due to maternal nondisclosure. The child developed ipsilateral axillary lymphadenitis at the BCG vaccination site shortly after starting ART. The clinical features and temporal association with ART supported a diagnosis of BCG-IRIS. The child was successfully managed with conservative pharmacological treatment alone—rifampicin, isoniazid, and macrolide therapy—without surgical incision or corticosteroids. Progressive improvement of the lesion was observed, and complete clinical resolution occurred over the following months, alongside immune recovery. This case underscores the importance of recognising BCG-IRIS, even in settings where HIV diagnosis may be delayed, and supports the feasibility of conservative management in paediatric patients, potentially avoiding surgical intervention in settings of localised disease.
Keywords: BCG vaccination; HIV; IRIS; BCG lymphadenitis BCG vaccination; HIV; IRIS; BCG lymphadenitis

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MDPI and ACS Style

Ivanov, D.; Strashimirov, D.; Grozdeva, R.; Penchev, E.; Georgieva, E.; Yancheva, N. Unmasking Bacillus Calmette–Guérin Immune Reconstitution Inflammatory Syndrome in a Perinatal HIV Transmission—A Case Report. Trop. Med. Infect. Dis. 2025, 10, 148. https://doi.org/10.3390/tropicalmed10060148

AMA Style

Ivanov D, Strashimirov D, Grozdeva R, Penchev E, Georgieva E, Yancheva N. Unmasking Bacillus Calmette–Guérin Immune Reconstitution Inflammatory Syndrome in a Perinatal HIV Transmission—A Case Report. Tropical Medicine and Infectious Disease. 2025; 10(6):148. https://doi.org/10.3390/tropicalmed10060148

Chicago/Turabian Style

Ivanov, Daniel, Dimitar Strashimirov, Rusina Grozdeva, Evgeni Penchev, Elena Georgieva, and Nina Yancheva. 2025. "Unmasking Bacillus Calmette–Guérin Immune Reconstitution Inflammatory Syndrome in a Perinatal HIV Transmission—A Case Report" Tropical Medicine and Infectious Disease 10, no. 6: 148. https://doi.org/10.3390/tropicalmed10060148

APA Style

Ivanov, D., Strashimirov, D., Grozdeva, R., Penchev, E., Georgieva, E., & Yancheva, N. (2025). Unmasking Bacillus Calmette–Guérin Immune Reconstitution Inflammatory Syndrome in a Perinatal HIV Transmission—A Case Report. Tropical Medicine and Infectious Disease, 10(6), 148. https://doi.org/10.3390/tropicalmed10060148

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