title: Multiple organ failure and granulomatous hepatitis following intravesical bacillus Calmette-Guérin instillation.
abstract: Intravesical instillations of Bacillus-Calmette Guérin are widely used in the treatment of superficial bladder carcinoma. Although relatively safe, it has potentially lethal systemic side effects. In this case report a 68 year old patient presented with septic shock and multiple organ failure three days after instillation with Bacillus Calmette-Guérin. After treatment with fluid, vasopressors, broad spectrum antibiotics and antimycobacterial drugs the patient's condition improved. Ten days after admission there was a dramatic increase in bilirubin levels. A liver biopsy revealed granulomatous hepatitis. After the initiation of methylprednisolone the overall condition of the patient improved and serum bilirubin levels returned to normal.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, AZ Groeninge, Kortrijk, Belgium. Matthias.Desmet@AZgroeninge.be
authors.forename: M
authors.initials: M
authors.lastname: Desmet
authors.forename: K
authors.initials: K
authors.lastname: Moubax
authors.forename: M
authors.initials: M
authors.lastname: Haerens
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects; D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006505:Hepatitis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000139:chemically induced* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine