title: Intravesical bacille Calmette-Guérin-induced multiorgan failure after treatment for transitional cell carcinoma.
abstract: Intravesical bacille Calmette-Guérin (BCG) has been safely used to treat stage Ta and T1 bladder carcinoma since 1976. This report presents the case of a 56-year-old man who presented with multiorgan failure after bacille Calmette-Guérin (BCG) treatment for stage T1 transitional cell carcinoma of the bladder. On admission the patient was jaundiced, had inflammatory infiltrates on chest radiography and required dialysis for renal failure. He had a persisting fever of unknown origin and elevated cholestatic liver function tests, which prompted a liver biopsy.This demonstrated hypersensitivity hepatic granuloma but no organism was identified. He responded well to steroid and antimycobacterial treatment. A small percentage of BCG-treated patients suffer hypersensitivity side-effects (pneumonitis, hepatitis or interstitial nephritis). This complication most commonly follows a traumatic installation. Mycobacteriumbovis is rarely cultured or identified using polymerase chain reaction techniques, and the diagnosis is based on histological findings of granuloma.
authors.affiliation: Department of Respiratory Medicine, St James’s Hospital, Dublin, Ireland. bridgetmkiely@yahoo.co.uk
authors.forename: Bridget
authors.initials: B
authors.lastname: Kiely
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: McLaughlin
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Lynch
authors.forename: Joseph
authors.initials: J
authors.lastname: Keane
mesh_terms: D000283:Administration, Intravesical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000188:drug therapy / Q000382:microbiology*; D009163:Mycobacterium bovis; D009367:Neoplasm Staging; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids