Intramuscular administration of BCG vaccine complicated by MRSA abscess requiring surgical grafting in a neonate: A case report

Published Date: 02nd September 2026

Publication Authors: Mehmood. F

Background
Bacillus Calmette–Guérin(BCG) vaccination is routinely administered intradermally at birth to prevent severe forms of tuberculosis. Incorrect administration can lead to rare but serious local complications.

Case presentation
We report a term neonate who inadvertently received intramuscular BCG injection in the right forearm. The infant presented on day 29th of life with fever, irritability, and right arm swelling, requiring NICU admission. Investigations revealed leukocytosis and markedly elevated inflammatory markers. Imaging confirmed an abscess, and incision and drainage with serial debridement were performed. Culture yielded Methicillin-resistant Staphylococcus aureus. Histopathology demonstrated suppurative inflammation with granulomatous features. The patient was managed with targeted intravenous antibiotics and repeated wound care, followed by split-thickness skin grafting due to significant tissue loss.

Conclusion
Accidental intramuscular administration of BCG can result in severe local complications, including secondary bacterial infection and mixed inflammatory pathology. Early recognition, appropriate surgical management, and targeted antimicrobial therapy are essential. This case underscores the importance of adherence to proper vaccination techniques to prevent avoidable morbidity.

Hashir, M; Mehmood, F et al. (2026). Intramuscular administration of BCG vaccine complicated by MRSA abscess requiring surgical grafting in a neonate: A case report. Clinical Infection in Practice. 32(December), p.Article No. 100724. [Online]. Available at: https://doi.org/10.1016/j.clinpr.2026.100724 [Accessed 17 September 2026]