Report: Fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn’s disease

Abstract

Abstract We present the case of a 28 year old lady with refractory Crohn's Disease treated with infliximab throughout her pregnancy. Her baby was born healthy and received a Bacillus Calmette-Guérin (BCG) vaccine aged 3 months. Soon after this the infant became unwell and died aged 4.5 months. At post-mortem the cause of death was attributed to an unusual complication of the BCG vaccine, known as disseminated BCG. BCG vaccination is contraindicated in individuals who are receiving immunosuppressive drugs. We recommend physicians should exercise caution before such vaccines are used in infants born to mothers taking anti-TNF therapies or other potentially immunosuppressive IgG1 antibodies. © 2010 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved. Case report This case is of a 28 year old Caucasian lady diagnosed with pan-colitis and erythema nodosum secondary to Crohn's Disease (CD) in 2001. She was treated early on with mesalazine and azathioprine at a dose of 2 mg per kg bodyweight but experienced recurrent flare-ups requiring repeated courses of prednisolone with eventual loss of response. In 2004, infliximab 5 mg/kg was commenced with initial good symptomatic benefit but subsequent loss of response. Therefore, in 2006 the dose of infliximab was increased to 10 mg/kg every eight weeks. In 2008 she became pregnant. The pros and cons of continuing infliximab were discussed at length with the patient. Due the severity and corticosteroid refractory nature of her CD, the benefits of maintaining remission with infliximab was felt to outweigh the risks of foetus exposure to the drug. She consented to continue eightweekly infusions of infliximab 10 mg/kg as monotherapy for CD. Her disease remained in remission during pregnancy and in July 2008 she gave birth to a healthy baby boy. The baby was born at 36 + 3 gestation via spontaneous vaginal deliver