Abstract
Intravesical Bacillus Calmette-Guérin (BCG) instillation is an established immunotherapy
for superficial bladder cancer. Herein, we describe a case of disseminated BCG infection
that developed immediately after the first BCG injection. A 76-year-old man diagnosed
with non-invasive bladder cancer underwent intravesical BCG instillation; he developed
high fever and systemic arthralgia later that night. General examination did not reveal
any infectious sources, and a combination therapy of isoniazid, rifabutin, and ethambutol
was initiated after collecting his blood, urine, bone marrow, and liver biopsy samples
for mycobacterial cultures. Three weeks later, Mycobacterium bovis was detected in the urine and bone marrow samples, and pathological investigation
of liver biopsy revealed multiple small epithelial granulomas with focal multinucleated
giant cells, leading to a diagnosis of disseminated BCG infection. The patient recovered
after long-term antimycobacterial therapy without remarkable sequelae. Most cases
of disseminated BCG infection occur after several doses of BCG injections, and its
onset reportedly varies among cases, ranging from a few days to several months. The
present case was notable as disease onset was observed only a few hours after the
first BCG injection. Although rare, development of disseminated BCG infection should
be considered as a differential diagnosis in patients at any time after intravesical
BCG instillation therapy.
Keywords
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Article info
Publication history
Published online: May 25, 2023
Accepted:
May 21,
2023
Received in revised form:
May 1,
2023
Received:
March 27,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
