Granulomatous chest disease following intravesical bacillus Calmette-Guerin immunotherapy

Bacillus Calmette-Guerin (BCG) is well accepted as an intravesicular method of treatment of bladder cancer. Although well tolerated in the majority of patients, adverse local and systemic adverse effects of this therapy have been described. In particular, lung disease complicating intravesicular use of BCG has been reported, producing 5 recognized forms of chest disease: 1) allergic interstitial lung disease, 2) miliary infection, 3) empyema, 4) diffuse alveolar damage, and 5) localized consolidative or cavitary lung disease. We report an asymptomatic form of pulmonary disease complicating intravesical BCG therapy, that of pulmonary granulomas with mediastinal and hilar lymph node enlargement.