Systemic Complications of Intravesical BCG Therapy for Bladder Cancer

Macrophage-Inducible C-Type Lectin Mincle-Expressing Dendritic Cells Contribute to Control of Splenic Mycobacterium bovis BCG Infection in Mice

“…Under certain conditions, dormant mycobacteria are reactivated and frequently disseminate to extrapulmonary organ systems, thereby establishing a severe clinical complication of pulmonary tuberculosis (8,(11)(12)(13). Notably, not only M. tuberculosis but also M. bovis BCG may cause mycobacterial dissemination in humans, as has been noted, e.g., in patients treated by intravesical M. bovis BCG therapy for bladder cancer, which may lead to systemic BCGitis, a severe systemic BCG infection (14). Therefore, elucidation of the molecular pathways underlying the control of systemic M. bovis BCG infection may also inform about the regulatory pathways controlling M. tuberculosis dissemination.…”

Disseminated Pulmonary Granulomas after Intravesical Bacillus Calmette-Guérin Immunotherapy

“…Systemic serious complications may not be apparent until several weeks after BCG administration. They in clude disseminated BCG infection in distant organs [8][9][10][11] (granulomatous hepatitis, prostatitis, renal abscess, retroperitoneal lymphadenopathy and miliary pulmonary disease) or systemic hypersensitivity reactions [12] (pan cytopenia, fever, hepatitis, pneumonitis, renal insuffi ciency). Ten fatal cases have been reported with sepsis or anaphylaxis related to intravesical use [13].…”

Complications of Intravesical Bacillus Calmette-Guérin

“…Among these, there were 2 deaths [42][43][44][45]. [36][37][38][39] All 6 patients met the criteria for systemic inflammatory immune response during the course of their illness. Common features include fever, hepatosplenomegaly, transaminitis, and elevated inflammatory markers.…”

“…At the tissue level, granulomatous nephritis, interstitial nephritis, and glomerulonephritis with immune deposits have been documented. [38][39][40][41][42][43][44][45][46] Patients may fit nephritic or nephrotic clinical criteria. Granulomatous nephritis may cause severe renal compromise; one case led to nephroureterectomy.…”