[Subacute meningoencephalitis following intravesical BCG instillation immunotherapy]

Intravesical instillation of Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, is the standard adjuvant treatment following transurethral resection of intermediate- and high-risk non-muscle-invasive urothelial carcinoma. Its therapeutic effect relies on intense local immune activation, reducing recurrence and progression rates and thereby improving patient outcomesand quality of life. Although generally well tolerated, both local and systemic infections and inflammatory complications may occur. We report a case of central nervous system BCG dissemination following intravesical BCG immunotherapy. The insidious onset and non-specific neurological manifestations complicated the diagnostic process and delayed the initiation of appropriate treatment. This case highlights the importance of thorough medical history assessment and maintaining a high index of suspicion in patients presenting neurological symptoms after intravesical BCG therapy.