title: Bilateral Iritis after Vaccine for Bladder Cancer.
abstract: OBJECTIVE
  Bacille Calmette-Guérin (BCG) is a vaccine that can be instilled into the urinary bladder as immunotherapy against superficial bladder cancer. Several case reports have implicated intravesical BCG in the development of uveitis. Patients treated with BCG therapy may present with systemic symptoms resembling reactive arthritis and, less frequently, have ocular adverse effects including bilateral panuveitis or chorioretinitis. In all but three previously reported cases of uveitis associated with BCG treatment, HLA-B27 has been positive. No patients have been reported to be positive for rheumatoid factor or antinuclear antibody (ANA).
  
  
  METHODS
  An HLA-B27-negative and low-positive ANA patient presented with bilateral uveitis after treatment with BCG therapy for superficial bladder cancer.
  
  
  CONCLUSIONS
  There is a need for greater awareness among urologists, primary care physicians, and optometrists of the potential for BCG to cause uveitis. These doctors should look for indicators of uveitis, such as circumlimbal conjunctival injection, photophobia, irregular pupils, and keratic precipitates. Together with appropriate treatment or prompt referral, this could prevent unnecessary morbidity. Future studies are needed to further elucidate the possible reasons for ANA positivity in these patients and the future role of the test in diagnosis and management.
authors.affiliation: *MD †MD, PhD Ophthalmology Department, Complejo Hospitalario de Pontevedra, Pontevedra, Spain (AP-F); and Clínica Oftalmológica Dr Parafita, Santa Eugenia de Ribeira, Spain (MAP).
authors.forename: Alberto
authors.initials: A
authors.lastname: Parafita-Fernández
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Parafita
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000283:Administration, Intravesical; D000974:Antibodies, Antinuclear / Q000097:blood; D001500:BCG Vaccine / Q000009:adverse effects*; D003519:Cyclopentolate / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004338:Drug Combinations; D005938:Glucocorticoids / Q000627:therapeutic use; D015796:HLA-B27 Antigen / Q000097:blood; D006801:Humans; D007167:Immunotherapy; D007500:Iritis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000627:therapeutic use; D001749:Urinary Bladder Neoplasms / Q000628:therapy*; D014606:Uveitis, Anterior / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000276:Adjuvants, Immunologic; D000974:Antibodies, Antinuclear; D001500:BCG Vaccine; D004338:Drug Combinations; D005938:Glucocorticoids; D015796:HLA-B27 Antigen; D009184:Mydriatics; D003907:Dexamethasone; D003519:Cyclopentolate