Comprehensive examination allowed to diagnose BCG-osteitis in 6 (50.0 %) patients, and focal hematogenous osteomyelitis in 6 (50.0 %). 10 patients underwent surgical treatment (bone resection at the level of pathological site with transplant replacement).
The x-ray patterns at BCG-osteitis and non-specific osteomyelitis were quite uniform: X-ray images and computed tomograms demonstrated that the bone lesion looked like homogeneous destruction foci, with locally indistinct, in places clear contours, with sclerotic rim and perifocal bone structure condensation.
The focal localization in case of BCG-associated osteitis was in the spongy part of a long bone (5 patients, fig.2-5) and in the wedge-shaped bone of the foot (1 patient), with a tendency to spread to the joint as a thinning end plate, a volume enlarged para-articular soft tissues (fig. 6, 7).
The patients with BCG-osteitis were aged 1-5 years, that together with x-ray data is one of the current diagnostic criteria for BCG-osteitis (Foucard T., 1971; Nishi J. et al., 1997): the post-BCG vaccination period is less than 4 years with the confirmed vaccination in the first year of life; no contact with tuberculosis patients was reported; typical x-ray signs of focal bone lesion were seen; presence of at least one of the signs: a) BCG bacterial strain isolation from the bone site; b) acid-resistant bacteria which are present in the material of bone lesion; c) histologically confirmed tuberculous bone lesion.
Among 6 patients aged 6-15 years with hematogenous osteomyelitis, in 3 patients the localization of changes was manifested in the diaphysis of the femur or tibia (fig. 8, 9), and despite the undertaken medical diagnostic osteoperforation, the process went on with formation of clear centers of destruction, hyperostosis and sclerosis of the osseous structure.
In another 3 patients, inflammatory changes were localized in the cuboid bone of the foot and in the epi-metaphysis of the long bone, but the process spread towards the diaphysis of the bone.
No multiple localization of the inflammatory process of any etiology was observed.
Histological examination of samples from osteomyelitis BCG foci revealed a granulomatous process with epithelioid cells and giant Langhans cells.