Abstract
We are reporting a case of culture-proven disseminated Mycobacterium Bovis infection (BCG-Osis), involving lung, bone-marrow and urinary tract, after intravesical Bacillus Calmette–Guérin (BCG) immunotherapy for bladder carcinoma-in-situ. A 71-year-gentleman presented with fever shortly after intravesical BCG instillation. He was initially treated for presumed Urinary Tract Infection, but negative urine culture and persistent fever prompted us to consider alternative diagnoses. Empirical treatment for BCG-Osis was commenced after initial negative workup including blood culture, echocardiography, computed tomography (CT) Chest, and Kidney-Ureter-Bladder (KUB). However, he remained febrile and leukopenic, so bone-marrow examination was performed along with repeating CT Chest, which revealed non-caseating granulomas and small nonspecific pulmonary nodules, respectively, supporting our provisional diagnosis. Interestingly, Mycobacterium Bovis was finally isolated from one of his urine specimens, confirming our diagnosis.
Highlights
Mycobacterium Bovis Bacillus Calmette–Guérin (BCG) immunotherapy has been used over many decades to treat bladder cancer in-situ with substantial efficacy [1, 2]
Despite one week of empirical gentamycin for presumed Urinary tract infection (UTI), he continued to spike temperature. Keeping his previous history of kidney stones in mind, a fresh CTKUB was requested, which did not show any hydronephrosis or change in size or position of the stone along with left adrenal adenoma. He subsequently had transthoracic echocardiography which did not reveal any evidence of infective endocarditis which was suspected because Streptococcus Bovis endocarditis has a wellknown association with colorectal cancer [5], computed tomography (CT) thorax was, requested, which revealed a 12-mm subcarinal lymph node along with sub-centimetre lymph nodes at the paratracheal region
4 Conclusions BCG-Osis is one of the rare and dangerous complications of intravesical BCG instillation which requires a high level of suspicion
Summary
Mycobacterium Bovis Bacillus Calmette–Guérin (BCG) immunotherapy has been used over many decades to treat bladder cancer in-situ with substantial efficacy [1, 2]. Keeping his previous history of kidney stones in mind, a fresh CTKUB was requested, which did not show any hydronephrosis or change in size or position of the stone along with left adrenal adenoma He subsequently had transthoracic echocardiography which did not reveal any evidence of infective endocarditis which was suspected because Streptococcus Bovis endocarditis has a wellknown association with colorectal cancer [5], CT thorax was, requested, which revealed a 12-mm subcarinal lymph node along with sub-centimetre lymph nodes at the paratracheal region. At this point (day 10 of his admission), the respiratory consultant suspected BCG-Osis clinically, and so, 3 successive early morning urine samples were sent for acidfast bacilli (AFB) and cultures. A shared decision, involving the patient and the multidisciplinary team (MDT), was made not to offer any further intravesical BCG and just continue endoscopic surveillance with the further plan of management if recurrence or progression occurs in the future
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
