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 Missouri Resident Poster Competition 1999 Minxiang Gu M.D.
St. Luke’s Medical Center Bacillus Calmette-Guerin (BCG) intravesical or intralesional
injection has been the best available treatment for recurrent
bladder transitional-cell carcinoma, and carcinoma in situ. Along
with the 80% efficacy, fewer than 5% of patients will have adverse
reactions range from minor cystitis to major, but rare, BCE sepsis.
Because of the common misconception that BCG is a harmless organism,
the diagnosis and treatment of BCG sepsis can be delayed. We report
a patient with a disseminated BCG sepsis as a side effect of BCG
bladder instillation. Case study: 68 year old male developed remittent fever 10 days
after second dose of BCG bladder instillation, with neutropenia, LFT
abnormality, pulmonary infiltration, and had no response to
broad-spectrum antibiotics. Liver biopsy revealed non-caseating
granulomas and bacillus-like organism was identified with
auramine-rhodamine stain. PCR of biopsy tissue was positive of bovus
mycobacterium DNA and culture of the tissue grown mycobacterium
tuberculosis. Patient responded to anti-tuberculosis treatment. Disseminated BCG infection is a rare but serious complication
associated with BCG bladder instillation. The early recognition and
initiation of empirical anti-tuberculosis treatment is important
when the patient developed a high fever after the procedure. |
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