BCG-induced pneumonitis with lymphocytic pleurisy in the absence of elevated KL-6

Abstract

BackgroundPneumonitis 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.Case presentationWe 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.ConclusionWe 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.

Varying clinical presentations of nontuberculous mycobacterial disease : Similar to but different from tuberculosis

“…Like HP, HTL shows apparent improvement either spontaneously or in response to glucocorticoid therapy after avoiding exposure to the pathogen without anti-NTM chemotherapy (39). The fact that bacillus Calmette-Guerin (BCG) immunotherapy for bladder cancer sometimes induces systemic granulomatous inflammation supports the hypothesis that HTL is an allergic reaction rather than an infection (40,41). In addition, the possibility of endobronchial spread of NTM (M. xenopi) was reported in an immunocompromised patient (42).…”

“…massilience. The ribosomal methyl transferase gene erm (41) confers inducible macrolide resistance (susceptible on day 3 but resistant on day 14 of DST) in M. abscessus ssp. abscessus and bolletii.…”

“…massiliense is susceptible to clarithromycin even after prolonged incubation because its erm (41) does not work (24-27). In Japan, the rapidly growing mycobacteria identification kit using nucleic acid chromatography (KANEKA Corporation, Osaka, Japan) has made it possible to evaluate MABC subspecies and the erm (41) genotype in clinical practice. Management of NTM disease requires regular assessment of microbial substitution and reconsideration of treatment plans.…”

Managing the adverse events of intravesical bacillus Calmette–Guérin therapy

“…From June 2014 to May 2015, we found another ten reports on severe complications. 14 – 23 So the things that can happen are very rare but quite impressive and in any organ of the body.…”

“… 44 Immunological reactions at any other organ in the body theoretically can be expected and are rarely described. 13 , 23 The diagnostic workup of these patients may be exhaustive given the broad range of causes of similar symptoms.…”