Interstitial pneumonitis secondary to intravesical bacillus calmette-guerin for carcinoma in-situ of the bladder

Abstract

We report an 81-year-old male who developed severe interstitial pneumonitis on maintenance intravesical Bacillus Calmette-Guerin (BCG) for in-situ carcinoma of the bladder.The patient was treated with steroids and anti-tuberculin therapy with complete response. While there is no established standard of care for the treatment of interstitial pneumonitis, recent reports describe success with combination of corticosteroids and anti-tuberculin medications.We elected to follow this precedent and treated our patient with corticosteroids and antituberculin therapy with good outcome.

Bacillus Calmette-Guérin pneumonitis after intravesical instillation: Report of two cases and a review of the literature

“…Combination of antituberculosis agents is recommended in the management of locoregional and systemic infection complicating intravesical BCG administration 6 . The use of corticosteroids has also been reported in the cases thought to be due to hypersensitivity response 13,49 , in combination with antituberculosis agents 19,35,50 , or after no improvement with standard antituberculosis therapy 51 .…”

Disseminated Bacillus Calmette-Guérin (BCG) Infection Caused By Inadvertent Intravenous Infusion of BCG for the Treatment of Bladder Cancer: Case Report

“…Our patient's treatment lasted for six months; however, the literature reported lengths of anti-tuberculosis treatment ranging from six to 12 months. 11 Even if patients fully recover from BCG sepsis following inadvertant BCG administration or intravesical instillation of BCG, mortality due to BCG sepsis is very high. Gonzalez et al reported a mortality rate of 25% for BCG sepsis.…”

Neumonitis granulomatosa por instilación endovesical de BCG

“…La afectación parenquimatosa granulomatosa en hígado y/o pulmón se ha descrito en el 0,7% de los casos. En pulmón ocasiona un cuadro de neumonitis con patrón radiográfico intersticial, acompañándose de manifestaciones sisté-micas como fiebre y síndrome constitucional 3 . La identificación de micobacterias en sangre, esputo o lavado broncoalveolar es muy difícil y el diagnóstico de certeza se establece mediante biopsia con hallazgos de granulomas similares a los de la TBC pulmonar clásica.…”