Intended for healthcare professionals

Endgames Spot Diagnosis

Oedema over an inoculation site

BMJ 2020; 368 doi: (Published 16 January 2020) Cite this as: BMJ 2020;368:l6823
  1. Nicholas Beng Hui Ng, paediatric registrar,
  2. Rajeev Ramachandran, paediatric consultant
  1. National University Hospital Singapore
  1. Correspondence to N B H Ng nicholas_bh_ng{at}

An 18 month old girl presented to the children’s emergency department with five days of fever (up to 40°C) associated with painful swelling in the left side of her neck. She had no accompanying respiratory symptoms. On examination, she had tender cervical lymph node enlargement with the largest node measuring 3×3 cm at the left anterior cervical chain. In addition, there was redness and oedema over the previously healed site of her BCG vaccine inoculation on the left upper arm (fig 1) (she had received this vaccine at birth, as per the local vaccination schedule). She had no conjunctival injection, mucosal erythema, oedema over the …

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