Intravesical Bacillus Calmette-Guérin (BCG) has been a proven and effective
immunotherapy treatment for superficial
transitional cell carcinoma (TCC) of the bladder, especially for high-grade
tumors and
carcinoma in situ. Nevertheless, significant side effects are associated with BCG instillations, including
fever,
myalgia, malaise,
dysuria,
hematuria, and irritable
lower urinary tract symptoms. We herein report the case of a patient who developed
Reiter's syndrome following intravesical BCG instillations. A 39-year-old Chinese man presented with a 3-week history of
dysuria, suprapubic
pain, and
pain at the tip of the penis postmicturition. Initial investigations revealed that he had microhematuria, and an ultrasound with computed tomography scan of the abdomen showed a bladder mass. Transurethral resection of the
bladder tumor was performed and the patient received a single dose of intravesical
mitomycin postoperatively. Results of histopathological examination revealed high-grade bladder TCC (G3pT1), and the patient was managed with intravesical BCG for 2 weeks following the surgery. Four weekly cycles of BCG were administered uneventfully; however, before the fifth instillation, the patient complained of urethral discharge, bilateral
conjunctivitis, and
low back pain.
Reiter's syndrome was diagnosed as a rare but known complication of BCG instillation and the BCG
immunotherapy was withheld. The patient was treated with nonsteroidal antiinflammatory drugs (for
back pain) and eye
ointment (for
conjunctivitis) and his condition improved. This case report of
Reiter's syndrome should be highlighted as a rare but significant complication of BCG
immunotherapy and urologists should have a high index of suspicion to diagnose this rare complication.