Abstract:  Lupus vulgaris is a rare form of cutaneous mycobacterial infection that can occur from mycobacterial exposure and even more rarely from exposure to the Bacillus Calmette-Guérin vaccine. We report a child who received this vaccination in China and then developed lupus vulgaris shortly after being adopted in the United States. After histopathologic confirmation, the infection was successfully treated with a combination of antibiotics. This occurrence demonstrates the need for heightened surveillance of Bacillus Calmette-Guérin vaccine-induced lupus vulgaris, given the increasing numbers of overseas adoptions taking place in the United States. To our knowledge, this is the first reported instance of Bacillus Calmette-Guérin immunization-induced lupus vulgaris in the United States.