A man in his seventies with dyspnoea and ataxia after BCG instillation for bladder cancer.

Abstract

BACKGROUND This case report introduces one of the first documented incidents of infectious complications of intravesical BCG immunotherapy in Norway. It took time to feel satisfied with the final diagnosis due to the diagnostic challenges related to obtaining positive results on microbiological analyses. CASE PRESENTATION A man in his seventies presented with malaise, fever and elevated liver enzymes after intravesical administration of BCG. He was given glucocorticoids against a potential hypersensitive reaction on the liver, but the patient soon returned with worsening general condition, persistent fever, cough and ataxia. CT thorax showed a miliary pattern in the lungs and brain MRI showed dural/meningeal enhancement. We were unable to detect viable bacilli in microbiological samples from the lungs, cerebral fluid or blood. Histologic finding of granulomas on lung biopsy, together with no other reasonable alternative diagnosis, was crucial for the decision to start antitubercular drugs. INTERPRETATION Although a rare complication, BCG infections should be considered early in patients developing illness after intravesical BCG instillation. The procedure is relatively common in Norwegian hospitals and adverse results do occur.