Miliary lung disease after intravesical bacillus Calmette-Guérin immunotherapy.

Abstract

Clinical and radiologic findings in a 73-year-old man who developed a systemic illness while receiving intravesical bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer are presented. Thin-section chest computed tomographic findings included a diffuse pattern of small nodules consistent with miliary disease. Potential mechanisms explaining the pulmonary disease resulting from intravesical BCG treatment include a hypersensitivity reaction or actual BCG infection of the lungs.

Fever of unknown origin and pancytopenia caused by culture-proven delayed onset disseminated bacillus Calmette-Guérin (BCG) infection after intravesical instillation

“…Aetiological confirmation is also difficult, as usually the AFB stain on histopathology, mycobacterial cultures and PCR are negative 10. This finding has led many authors to postulate that the pathogenesis of this disease is hypersensitivity mediated rather than septic,3 11 although case reports have demonstrated viable organisms in a variety of tissues 12–15…”

Case Presentation: Lung Consolidation as Sequelae of BCG Sepsis After Combined Intravesical and Intraurethral BCG

“…In addition to generalized symptoms, such as fever and malaise, dyspnea and eventual respiratory failure may follow. While pulmonary complications are rare they classically are associated with 2 forms: pneumonitis and disseminated miliary 1 . CT imaging in these patients' typically show nodular or interstitial patterns, different then the consolidation seen this patient.…”

Systemic granulomatous reaction secondary to treatment of bladder cancer with Bacillus Calmette-Guerin

“…Bone marrow involvement during disseminated disease with BCG has been reported in only a few cases, where patients showed involvement of the lungs and/or the liver in addition to bone marrow infiltration as part of a septic process,4 while miliary tuberculosis represents the most frequent pulmonary complication 2,5,6…”