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Systemic Bacillus Calmette-Guerin Infection One Year After Intravesical Immunotherapy Mimicking Sarcoidosis
Yashswee Kc1, Mohit Gupta2, Gail E Reid3
1Rheumatology, Loyola University Medical Center, Maywood, USA.
Cureus
|December 23, 2022
Summary
Bacillus Calmette-Guerin (BCG) immunotherapy for bladder cancer can lead to sarcoidosis and Mycobacterium bovis infection. This case highlights the rare but serious complications of BCG treatment, resulting in fatal sepsis.
Area of Science:
- Immunology
- Oncology
- Infectious Diseases
Background:
- Intravesical Bacillus Calmette-Guerin (BCG) is a standard immunotherapy for bladder cancer.
- BCG immunotherapy can rarely cause systemic side effects, including granulomatous reactions.
Observation:
- A patient developed pancytopenia and hypercalcemia post-BCG treatment.
- Bone marrow biopsy showed noncaseating granulomas, leading to a sarcoidosis diagnosis and prednisone treatment.
- Despite initial improvement, the patient later presented with sepsis.
Findings:
- Blood cultures identified Mycobacterium bovis, a component of BCG, as the cause of sepsis.
- The patient's condition deteriorated despite triple antibiotic therapy, leading to mortality.
Implications:
- This case underscores the potential for disseminated BCG infection mimicking sarcoidosis.
- Clinicians should maintain a high index of suspicion for mycobacterial infection in patients with BCG exposure and systemic symptoms.
- Early and accurate diagnosis is crucial for managing these rare but severe BCG-related complications.
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