title: BCG-induced pneumonitis with lymphocytic pleurisy in the absence of elevated KL-6.
abstract: BACKGROUND
  Pneumonitis is a rare complication of bacillus Calmette-Guerin (BCG) immunotherapy seen in patients with urothelial cancer following the repeated administration of BCG. However, no case of BCG-induced pleurisy has been reported.
  
  
  METHODS
  We here report the first case of pneumonitis with lymphocytic pleurisy following bacillus Calmette-Guerin (BCG) immunotherapy. Although marked T helper cell alveolitis was found by bronchoalveolar lavage and transbronchial biopsies, no acid-fast bacillus could be identified in recovered BALF or pleural effusion. The lymphocyte stimulation test of BCG was strongly positive. However, levels of serum and bronchoalveolar lavage fluid KL-6, a useful marker for hypersensitivity pneumonitis (HP), were within normal ranges.
  
  
  CONCLUSIONS
  We speculate that the pathogenesis of our case may be a hypersensitive reaction to the proteic component of BCG entering the lung and pleural space, which is different from the etiology of the common type of HP.
authors.forename: Makoto
authors.initials: M
authors.lastname: Tobiume
authors.affiliation: Department of Clinical Investigation, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi 780-8077, Japan. shinoharat@kochi2.hosp.go.jp.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Shinohara
authors.forename: Takahira
authors.initials: T
authors.lastname: Kuno
authors.forename: Shinji
authors.initials: S
authors.lastname: Mukai
authors.forename: Keishi
authors.initials: K
authors.lastname: Naruse
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hatakeyama
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Ogushi
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects* / Q000627:therapeutic use; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy; D008214:Lymphocytes; D010998:Pleurisy / Q000139:chemically induced* / Q000150:complications*; D011014:Pneumonia / Q000139:chemically induced* / Q000150:complications*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine