Corticosteroid-associated fatal mycobacterial sepsis occurring 3 years after instillation of intravesical bacillus Calmette-Guerin.
A case is reported of systemic Mycobacterium bovis infection that occurred 3 years after uneventful instillation of intravesical bacillus Calmette-Guerin (BCG) and after several months of oral prednisone therapy. The literature on delayed BCG infection and the systemic persistence of BCG after intravesical instillation is reviewed. We propose that rarely a reservoir of dormant M. bovis may become established after intravesical therapy. Reactivation infection may later develop in a manner that parallels the natural history of secondary tuberculosis.
Izes
J K
JK
Department of Urology, Lahey Clinic, Burlington, Massachusetts 01805.
Bihrle
W
W
Thomas
C B
CB
D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009163:Mycobacterium bovis; D011241:Prednisone / Q000009:adverse effects*; D013997:Time Factors; D014376:Tuberculosis / Q000209:etiology*; D001749:Urinary Bladder Neoplasms / Q000628:therapy
D001500:BCG Vaccine; D011241:Prednisone