Intravesical bacillus Calmette-Guerin (BCG) has been established as an effective treatment of superficial
bladder cancer (Parker and Kommu, 2013). However, major side effects, including
pneumonitis,
sepsis, and even death, may occur in <5% of patients (Gonzalez et al., 2003). Here we present a case of severe disseminated Mycobacterium bovis following intravesical BCG administration. Our patient is a 76-year-old gentleman with newly diagnosed superficial
transitional cell carcinoma of the bladder who recently received his first intravesical BCG treatment. He initially presented with
hemoptysis and was found to have extensive patchy infiltrates bilaterally. He was treated for
pneumonia with
antibiotics and then with
steroids for
hypersensitivity pneumonitis but continued to deteriorate. Due to the temporal proximity of his exposure to BCG, we administered treatment for presumed disseminated BCG
infection with
rifampin,
isoniazid, and
ethambutol. Within a 48-hour period, the patient improved dramatically. The reported cases of
infection from intravesical BCG illustrate an insidious onset with initial symptoms of low-grade
fevers and
cystitis but may progress to
pneumonitis. If the symptoms persist for more than 7 days or if there is
clinical deterioration, RIPE
therapy (with
rifampin,
isoniazid,
pyridoxine, and
ethambutol) and a
fluoroquinolone should be administered for a 6-9-month course along with
steroids for 4-6 weeks (Naudžiunas et al., 2012).