title: Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy: Case report.
abstract: BACKGROUND
  Intravesical instillation of Bacillus Calmette-Guérin (BCG) is the treatment of choice for superficial bladder carcinoma. Complications of BCG therapy include local infections and disseminated BCG infection with multiple endorgan complications.
  
  
  METHODS
  We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis. After successful anti-mycobacterial therapy and resolution of the hepatic and ocular abnormalities, the patient developed an acute upper gastrointestinal hemorrhage from an aortoduodenal fistula that required emergency surgery. The resection specimen revealed multifocal, non-caseating granulomas, indicating mycobacterial involvement.
  
  
  CONCLUSIONS
  This case highlights the varied end organ complications of disseminated BCG infection, and the need for vigilance even in immuno-competent patients with a history of intravesical BCG treatment.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL 60153, USA. cfimmel@lumc.edu
authors.forename: Cindy Q
authors.initials: CQ
authors.lastname: Gao
authors.forename: Rozina
authors.initials: R
authors.lastname: Mithani
authors.forename: Jack
authors.initials: J
authors.lastname: Leya
authors.forename: Lesley
authors.initials: L
authors.lastname: Dawravoo
authors.forename: Arvin
authors.initials: A
authors.lastname: Bhatia
authors.forename: John
authors.initials: J
authors.lastname: Antoine
authors.forename: Felipe
authors.initials: F
authors.lastname: De Alba
authors.forename: Peter A
authors.initials: PA
authors.lastname: Russo
authors.forename: Claus J
authors.initials: CJ
authors.lastname: Fimmel
mesh_terms: D000283:Administration, Intravesical; D000995:Antitubercular Agents / Q000008:administration & dosage; D001011:Aorta / Q000473:pathology; D001688:Biological Products / Q000008:administration & dosage / Q000009:adverse effects*; D002277:Carcinoma / Q000628:therapy; D002833:Choroiditis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D005402:Fistula / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D006105:Granulomatous Disease, Chronic / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D006505:Hepatitis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009163:Mycobacterium bovis / Q000276:immunology / Q000472:pathogenicity*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000628:therapy
chemical_list: D000995:Antitubercular Agents; D001688:Biological Products