title: Systemic BCG infection in a patient with pancytopaenia and fever 9 years after intravesical BCG administration for bladder cancer.
abstract: BCG is an attenuated live strain of Mycobacterium bovis that is used as an intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG instillation can lead to systemic diseases. We present a case of a 75-year-old man who was treated for recurrent localised transitional cell carcinoma (TCC) of the bladder with intravesical instillation of BCG in 2006. His medical history included Parkinson's disease. The patient reported worsening of Parkinson symptoms in the preceding month. In addition, he had progressive pancytopaenia and a bone marrow biopsy showed a granulomatous inflammatory infiltrate. Cultures from bone marrow aspiration grew M. bovis He was successfully treated with tuberculostatic drugs and made a full recovery. In addition, there was partial amelioration of the Parkinson symptoms. This case shows that physicians should be aware that BCG instillation for TCC can cause systemic disease even years after treatment.
authors.affiliation: Department of Geriatrics, Jessa Ziekenhuis, Hasselt, Belgium.
authors.forename: Ine M
authors.initials: IM
authors.lastname: Westhovens
authors.affiliation: Department of Geriatrics, Jessa Ziekenhuis, Hasselt, Belgium.
authors.forename: Marie-Elena
authors.initials: ME
authors.lastname: Vanden Abeele
authors.affiliation: Department of Infectious Diseases and Immunity, Jessa Ziekenhuis, Hasselt, Belgium BIOMED Research Institute, Universiteit Hasselt, Hasselt, Belgium.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Messiaen
authors.affiliation: BIOMED Research Institute, Universiteit Hasselt, Hasselt, Belgium Jessa Ziekenhuis, Hasselt, Belgium.
authors.forename: Jeroen Ch
authors.initials: JCh
authors.lastname: van der Hilst
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000009:adverse effects* / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000473:pathology; D005334:Fever / Q000209:etiology*; D006801:Humans; D008297:Male; D010198:Pancytopenia / Q000209:etiology*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000382:microbiology*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology
chemical_list: D000995:Antitubercular Agents; D001500:BCG Vaccine