International Journal of Dermatology 2009, 48, 00–00 © 2009 The International Society of Dermatology 546 Correspondence 20 Oh CK, Son HS, Kwon YW, et al. Intralesional fluorouracil injection in infantile digital fibromatosis. Arch Dermatol 2005; 141: 549–550. 21 Weiss E, Amini S. A novel treatment for knuckle pads with intralesional fluorouracil. Arch Dermatol 2007; 143: 1458–1460. 22 Heuer DK, Parrish RK 2nd, Gressel MG, et al. 5-fluorouracil and glaucoma filtering surgery. II. A pilot study. Ophthalmology 1984; 91: 384–394. 23 Conejo-Mir JS, Sanz Guirado S, Angel Muñoz M. Adverse granulomatous reaction to Artecoll treated by intralesional 5-fluorouracil and triamcinolone injections. Dermatol Surg 2006; 32: 1079–1081. 24 Sidwell RU, McL Johnson N, Francis N, et al. Cutaneous sarcoidal granulomas developing after Artecoll facial cosmetic filler in a patient with newly diagnosed systemic sarcoidosis. Clin Exp Dermatol 2006; 31: 208–211. 25 Kontochristopoulos G, Stefanaki C, Panagiotopoulos A, et al. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol 2005; 52 (3 Part 1): 474–479. 26 Nanda S, Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg 2004; 30: 54–56. 27 Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg 2006; 32: 907–915. 28 Apikian M, Goodman G. Intralesional 5-fluorouracil in the treatment of keloid scars. Australas J Dermatol 2004; 45: 140–143. Correspondence A rare complication of BCG vaccination The Bacillus Calmette-Guérin (BCG) vaccine contains a live, attenuated strain of bovine tuberculin bacteria Mycobacterium bovis. This vaccine is used worldwide on a large scale to protect children and adults against tuberculosis. Complications after a BCG vaccination are relatively rare and vary from local reactions to disseminated BCG infections. We report a patient with a chronic progressive granulomatous plaque at the site of vaccination, a highly unusual complication of BCG vaccination. A healthy 52-year-old woman received a BCG vaccination 30 years earlier. A few weeks afterwards, a plaque developed at the vaccination site, gradually enlarging over the years. Dermatological examination showed a round, red-brown plaque of 7 cm in diameter, consisting of multiple scaly papules and nodules (Fig. 1). Skin biopsy (Fig. 2) revealed acanthosis and parakeratosis of the epidermis and a dense lymphocytic infiltrate with scattered epithelioid histiocytes, Langhans’ giant cells and some noncaseating granulomas in the dermis. No crystals were identified with polarized light microscopy. No microagents were depicted using auramine, Ziehl-Neelsen, and Wade-Fite stains. The direct PCR on M. tuberculosis complex, and culture for mycobacteria were both negative. Chest X-ray and laboratory tests, including total proteins, calcium, ACE, lysozyme, HIV-1 and -2 serology were normal. The cellular nonantigen-specific immune system was extensively investigated, revealing no gross abnormalities. After we made the diagnosis of chronic BCG granuloma, the patient was successfully treated with isoniazid and prednisone daily for 5 months. Annually, 100 million children are vaccinated worldwide with BCG vaccine to protect them against tuberculosis. 1 Complications after vaccination consist of abscess formation, keloid, ulceration, lymphadenitis, urticaria, erythema multiforme, and most severe disseminated BCG-itis, sometimes with fatal consequences. 1–3 Figure 1 Above: before treatment. A solitary, more or less round, red-brown plaque (7 cm in diameter) with sharp borders consisting of multiple lenticular papules and nodules with limited scaling on the left shoulder Under: after treatment. Residual abnormality on the left shoulder after treatment with prednisone and isoniazid. Note the peripheral postinflammatory hyperpigmentations and a pink squamous thin plaque (2 cm in diameter) at the centre International Journal of Dermatology 2009, 48, 546–548 © 2009 The International Society of Dermatology