1999 Resident Poster Competition
Minxiang Gu M.D.
St. Luke's Medical Center
Disseminated Bacillus Calmette-Guerin (BCG) Infection After BCG Bladder Instillation
Bacillus Calmette-Guerin (BCG) intravesical or intralesional injection has been the best available treatment for recurrent bladder transitional-cell carcinoma, and carcinoma in situ. Along with the 80% efficacy, fewer than 5% of patients will have adverse reactions range from minor cystitis to major, but rare, BCE sepsis. Because of the common misconception that BCG is a harmless organism, the diagnosis and treatment of BCG sepsis can be delayed. We report a patient with a disseminated BCG sepsis as a side effect of BCG bladder instillation.
Case study: 68 year old male developed remittent fever 10 days after second dose of BCG bladder instillation, with neutropenia, LFT abnormality, pulmonary infiltration, and had no response to broad-spectrum antibiotics. Liver biopsy revealed non-caseating granulomas and bacillus-like organism was identified with auramine-rhodamine stain. PCR of biopsy tissue was positive of bovus mycobacterium DNA and culture of the tissue grown mycobacterium tuberculosis. Patient responded to anti-tuberculosis treatment.
Disseminated BCG infection is a rare but serious complication associated with BCG bladder instillation. The early recognition and initiation of empirical anti-tuberculosis treatment is important when the patient developed a high fever after the procedure.
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Alan D Forker, MD MACP
Missouri Chapter Governor
Patrick Mills
Missouri Chapter Executive Director
