Bacillus Calmette-Guérin-induced granulomatous hepatitis in a patient with a superficial bladder carcinoma.
A 71-year-old male patient with a superficial transitional cell carcinoma of the urinary bladder developed high fever and jaundice, accompanied by progressively increasing serum aminotransferase activities, 2 weeks after the fourth local instillation with an attenuated live strain of Mycobacterium bovis [bacillus Calmette-Guérin (BCG)]. A liver biopsy showed non-caseating granulomatous hepatitis. Cultures for mycobacteria were negative. Mycobacterial DNA was not detected in liver tissue using the polymerase chain reaction. Empirical treatment with rifampicin and isoniazid was started, resulting in partial recovery. After 6 months of therapy, however, serum aminotransferase activities were still twice the upper limit of normal. A second liver biopsy still demonstrated several granulomas. Only after addition of prednisolone, liver tests completely normalized. Also histologically the lesions improved dramatically. This suggests that the BCG hepatitis was at least partially caused by a hypersensitivity reaction. Our patient is the first reported case of BCG hepatitis with histological follow-up under therapy.
Van Outryve
Steven M
SM
Department of Gastroenterology and Hepatology, University Hospital of Antwerp, University of Antwerp, Belgium.
Francque
Sven M
SM
Gentens
Paul A
PA
De Pauw
Filip F
FF
Van den Bogaert
Erika
E
Van Marck
Eric A
EA
Pelckmans
Paul A
PA
Michielsen
Peter P
PP
D000276:Adjuvants, Immunologic / Q000009:adverse effects* / Q000627:therapeutic use; D000283:Administration, Intravesical; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D004342:Drug Hypersensitivity / Q000209:etiology / Q000276:immunology / Q000473:pathology; D004359:Drug Therapy, Combination; D006505:Hepatitis / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007538:Isoniazid / Q000627:therapeutic use; D008099:Liver / Q000276:immunology / Q000473:pathology; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology
D000276:Adjuvants, Immunologic; D000995:Antitubercular Agents; D001500:BCG Vaccine; D007166:Immunosuppressive Agents; D011239:Prednisolone; D000637:Transaminases; D007538:Isoniazid; D012293:Rifampin