Abstract
The standard therapy for superficial stages Ta and T1 or CIS transitional cell carcinoma of the bladder is repeated intravesical instillations of live bacteria of bacillus CalmetteGuerin (BCG). The mechanism of action of effective treatment is closely related to the induction of inflammatory immune response in the bladder. The most common side effect of BCG is cystitis and its incidence ranges from 5 to 95% depending on the definition used.' Typically, cystitis begins after the BCG instillation 3 and resolves within a few days. Persistent cystitis is treated effectively with short-term antituberculous antibiotics such as isoniazid. We report on a man in whom severe BCG induced cystitis developed after 6 intravesical instillations of Connaught BCG for the treatment of superficial bladder cancer. Severe symptoms of dysuria, frequency, bladder spasms and diminished bladder capacity persisted for 16 months, despite optimal medical treatment which included antituberculous antibiotics and intravesical hydrocortisone. The patient responded dramatically and rapidly to oral prednisone.
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