The First Case of Bacillus Calmette-Guérin-Induced Autoimmune Encephalitis

Intravesical bacillus Calmette-Guerin (BCG) therapy is a standard treatment for intermediate to high-risk non-muscle invasive bladder cancer. While local side effects are common, systemic complications are rare and can be serious.

A 69-year-old man presented with episodes of fever, headache, and impaired consciousness. He had undergone intravesical BCG therapy 3 days before presentation. He was initially diagnosed with viral encephalitis and treated with acyclovir, but showed no clinical improvement. Given the lack of response, autoimmune encephalitis was suspected, and steroid therapy was initiated, resulting in marked clinical improvement. Plasmapheresis was performed in addition to steroid therapy, and his condition improved to the level observed prior to BCG treatment. To date, he remains stable and relapse-free.

To our knowledge, this is the first reported case of BCG-induced autoimmune encephalitis after intravesical therapy.