Super acute-onset disseminated BCG infection: A case report

Intravesical Bacillus Calmette-Guérin (BCG) instillation is an established immunotherapy for superficial bladder cancer. Herein, we describe a case of disseminated BCG infection that developed immediately after the first BCG injection. A 76-year-old man diagnosed with non-invasive bladder cancer und...

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Bibliographic Details
Published in:Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2023-09, Vol.29 (9), p.919-921
Main Authors: Takase, Ryosuke, Hagiya, Hideharu, Fujimori, Takumi, Yokoyama, Yukika, Iio, Koji, Honda, Hiroyuki, Hasegawa, Kou, Otsuka, Fumio
Format: Article
Language:English
Subjects:
Administration, Intravesical
Aged
Bacillus calmette-guérin (BCG)
BCG Vaccine - adverse effects
Bone Marrow
Disseminated infection
Humans
Intravesical BCG instillation Therapy
Male
Mycobacterium bovis
Tuberculosis - diagnosis
Urinary Bladder Neoplasms - drug therapy
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Summary:Intravesical Bacillus Calmette-Guérin (BCG) instillation is an established immunotherapy for superficial bladder cancer. Herein, we describe a case of disseminated BCG infection that developed immediately after the first BCG injection. A 76-year-old man diagnosed with non-invasive bladder cancer underwent intravesical BCG instillation; he developed high fever and systemic arthralgia later that night. General examination did not reveal any infectious sources, and a combination therapy of isoniazid, rifabutin, and ethambutol was initiated after collecting his blood, urine, bone marrow, and liver biopsy samples for mycobacterial cultures. Three weeks later, Mycobacterium bovis was detected in the urine and bone marrow samples, and pathological investigation of liver biopsy revealed multiple small epithelial granulomas with focal multinucleated giant cells, leading to a diagnosis of disseminated BCG infection. The patient recovered after long-term antimycobacterial therapy without remarkable sequelae. Most cases of disseminated BCG infection occur after several doses of BCG injections, and its onset reportedly varies among cases, ranging from a few days to several months. The present case was notable as disease onset was observed only a few hours after the first BCG injection. Although rare, development of disseminated BCG infection should be considered as a differential diagnosis in patients at any time after intravesical BCG instillation therapy.
ISSN:1341-321X
1437-7780
DOI:10.1016/j.jiac.2023.05.017