Hypersensitivity pneumonitis following intravesical bacille Calmette-Guérin immunotherapy for superficial bladder cancer.
Hypersensitivity pneumonitis (HP) can be caused by drugs administered via routes other than the airway. We report a case of HP caused by intravesical bacille Calmette-Guerin (BCG) administered for the treatment of bladder cancer. We attempt to identify the causative agents of HP. A 60-year-old, nonsmoking homemaker was referred to our hospital with nonresolving pneumonia. The patient had dyspnea, cough, and fever that started after 3 weekly cycles of intravesical BCG. High-resolution computed tomography of the chest revealed multiple tiny nodules and ground-glass opacities on both lung fields. Pulmonary function tests revealed a restrictive ventilatory defect with decreased diffusion capacity. Histopathology of the transbronchial lung biopsy specimens showed immature noncaseating granulomata. Immunoblotting analysis of serum and BCG demonstrated more than 10 immunoglobulin G fractions binding to BCG. This case illustrates that HP can be caused by intravesical instillation of BCG.
Um
S-J
SJ
Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea.
Lee
S-K
SK
Yang
D-K
DK
D000283:Administration, Intravesical; D000542:Alveolitis, Extrinsic Allergic / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects*; D008875:Middle Aged; D009163:Mycobacterium bovis / Q000276:immunology*; D001749:Urinary Bladder Neoplasms / Q000276:immunology / Q000628:therapy*