CASE REPORT
BCG pneumonitis with a miliary radiological pattern complicating intravesical BCG immunotherapy
 
More details
Hide details
1
Pneumonologist, 1st Pulmonary Clinic, General Regional Hospital “G. Papanikolaou”. Thessaloniki
2
Trainee Pneumonologist, 1st Pulmonary Clinic, General Regional Hospital “G. Papanikolaou”. Thessaloniki
3
Pneumonologist, Coordinating Director, 1st Pulmonary Clinic, General Regional Hospital “G. Papanikolaou”. Thessaloniki
CORRESPONDING AUTHOR
 Evangelia Fouka   

General Regional Hospital “G. Papanikolaou”, Exochi 57010, Thessaloniki,
 
Pneumon 2010;23(4):388–391
 
KEYWORDS
ABSTRACT
The case is described of a 42 year-old male who presented with fever, haematuria, hypoxaemia, impaired liver function and a miliary pattern on chest X-ray while receiving intravesical BCG treatment for superficial bladder cancer. Initiation of antituberculous therapy resulted in rapid amelioration of the symptoms and the X-ray findings, and the patient left hospital in a good general state of health. Although M. bovis was not isolated from samples of sputum, bronchioalveolar lavage fluid (BALF) or bronchial biopsy tissue, the prompt response to antituberculous therapy suggests an infectious aetiology due to microbial dissemination. 
 
REFERENCES (16)
1.
Morales A, Eidinger D, Bruce AW. Intracavitary Bacillus CalmetteGuerin in the treatment of superficial bladder tumors. J Urol 1976; 116:180-3.
 
2.
Lamm DL, van der Meijden AP, Morales A, et al. Incidence and treatment of complications of bacillus Calmette-Guèrin intravesical therapy in superficial bladder cancer. J Urol 1992; 147:596-600.
 
3.
Witjes JA. Bladder carcinoma in situ in 2003: State of the art. Eur Urol 2004; 45:142-6.
 
4.
Kapoor R, Vijjan V, Singh P. Bacillus Calmette-Guèrin in the management of superficial bladder cancer. Indian J Urol 2008; 24(1):72-6.
 
5.
Lamm DL. Complications of bacillus Calmette-Guérin immunotherapy. Urol Clin North Am 1992; 19(3): 565-72.
 
6.
Soylu A, Ince AT, Polat H et.al. Peritoneal tuberculosis and granulomatous hepatitis secondary to treatment of bladder cancer with Bacillus Calmette-Guèrin. Ann Clin Microbiol Antimicrob 2009. 15; 8:12.
 
7.
Mc Parland C, Cotton DJ, Gowda KS et al. Milliary Mycobacterium bovis induced by intravesical bacille Calmette-Guèrin immunotherapy. Am Rev Respir Dis 1992; 146: 1330-3.
 
8.
Gupta RG, Lavengood R, Smith JP. Milliary tuberculosis due to intravesical bacillus Calmette-Guèrin therapy. Chest 1988; 94:1296-8.
 
9.
Frickman H, Jungblat S, Hanke P, Bargon J. Tuberculosis induced by Bacillus Calmette-Guèrin immunoprophylaxis – case study. Pneumonologie 2004;58(11):773-6.
 
10.
Tetikkurt C, Tetikkurt S, Bayar N et al. Endobronchial involvement in Miliary Tuberculosis. Pneumon 2010; 23(2):135-140.
 
11.
Dederke B, Riecken EO, Weinke T. A case of BCG sepsis with bone marrow and liver involvement after intravesical BCG instillation. Infection 1998; 26:54-57.
 
12.
Shimisaki N, Yamasaki I, Kamada M, Syuin T. Two cases of successful treatments with steroid for local and systemic hypersensitivity reaction following intravesical instillation of Bacillus Calmette-Guèrin. Hinyokika Kiyo 2001; 47:281-284.
 
13.
Molina JM, Rabian C, D’Agay MF, Modai J. Hypersensitivity systemic reaction following intravesical bacillus Calmette-Guerin: successful treatment with steroids. J Urol 1992;147(3):695-7.
 
14.
Jasmer RM, Mc Cowin MJ, Webb WR. Milliary lung disease after intravesical bacillus Calmette-Guèrin immunotherapy. Radiology 1996; 201:43-44.
 
15.
Rabe J, Neff KW, Lehmann KJ et.al. Milliary tuberculosis after intravesical bacille Calmette-Guèrin immunotherapy for carcinoma of the bladder. AJR 1999; 172:748-750.
 
16.
Rischmann P, Desgrandchamps F, Malavaud B, Chopin DK. BCG intravesical instillations: recommendations for side-effects management. Eur Urol 2000; 37 Suppl 1:33-6.
 
eISSN:1791-4914
ISSN:1105-848X