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Rare Complication of Intravesical BCG Therapy for Bladder Cancer: Case Report

By: Julia Fiederlein
Posted: Monday, May 24, 2021

A patient profile published in QJM: An International Journal of Medicine documented a case of disseminated Bacillus Calmette-Guérin (BCG) infection, which arose after intravesical BCG immunotherapy for bladder cancer. Sathish Ramalingam, MD, of Lovelace Medical Center, Albuquerque, and colleagues recommended an antituberculous and corticosteroid regimen to treat this condition.

“Disseminated BCG infection is a rare complication of intravesical administration of BCG, a live attenuated strain of Mycobacterium bovis for bladder cancer. The clinical manifestations may include localized or systemic manifestations, including fever, sweats, weight loss, pneumonitis, and hepatitis,” the investigators commented. “The physician should be aware that intravesicular BCG administration can develop a life-threatening disseminated infection or even death in severe untreated cases.”

A 78-year-old man with a history of bladder cancer presented with fatigue, cough, night sweats, and weight loss. He previously underwent transurethral resection of a noninvasive bladder tumor and was treated with intravesical BCG immunotherapy.

The patient underwent a CT scan of the chest upon admittance, which revealed bilateral fine reticular-nodular abnormalities. Multiple noncaseating granulomas were found during bronchoscopy and bone marrow biopsy. The results of a special stain and culture were negative for acid-fast bacilli. The patient was diagnosed with disseminated BCG infection and was subsequently administered rifampin, isoniazid, and ethambutol. After experiencing increased fatigue and weight loss for 2 weeks, he discontinued treatment with rifampin. The patient was administered ethambutol, isoniazid, moxifloxacin, and prednisone for 12 months; as a result, his symptoms resolved.

Disclosure: The study authors reported no conflicts of interest.



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