Systemic Bacillus Calmette-Guérin (BCG) Infection in a Patient With Non-Muscle-Invasive Bladder Cancer: A Case Report

Area of Science:

• Oncology
• Infectious Diseases
• Urology

Background:

• Intravesical Bacillus Calmette-Guérin (BCG) is a standard adjuvant therapy for non-muscle-invasive bladder cancer (NMIBC).
• While generally safe, systemic BCG infection is a rare but severe complication.
• Diagnosis can be difficult due to often negative microbiological findings.

Observation:

• A case report of a 67-year-old immunocompetent male treated for NMIBC with BCG.
• The patient presented with persistent fever and systemic symptoms, initially misdiagnosed as a urinary tract infection.
• Worsening condition despite antibiotics prompted further investigation.

Findings:

• Systemic BCG infection was suspected based on clinical presentation, including prolonged fever and asthenia.
• Antituberculosis treatment (rifampicin, ethambutol, isoniazid) was initiated promptly.
• The patient achieved a full recovery following antituberculosis therapy.

Implications:

• Highlights the importance of considering systemic BCG infection in patients with persistent unexplained fever post-BCG therapy.
• Emphasizes the need for prompt diagnosis and initiation of appropriate treatment to prevent life-threatening complications.
• Underscores the diagnostic challenges posed by negative microbiological cultures in systemic BCG infections.