Ces Urol 2019, 23(2):140-148 | DOI: 10.48095/cccu2019017

Miliary BCG-pneumonitis: a rare complication of intravesical BCG therapy

Barbora Nechanská¹, Jan Zaplatílek¹, Richard Pabišta¹, Olga Zadražilová²

¹ Urologické oddělení, Oblastní nemocnice Mladá Boleslav, a. s., Mladá Boleslav

² Plicní oddělení, Oblastní nemocnice Mladá Boleslav, a. s., Mladá Boleslav

Nechanská B, Zaplatílek J, Pabišta R, Zadražilová O. Miliary BCG-pneumonitis: a rare complication of intravesical BCG therapy. Adjuvant intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) vaccine is an effective treatment for patients with high risk non-muscle-invasive bladder carcinoma. The therapy is usually well tolerated and accompanied only by local or mild systemic symptoms (dysuria, mild increase of body temperature). Life-threatening systemic complications (nephritis, pneumonitis, BCG - sepsis) occur rarely. Their diagnostics can be challenging due to non-specific symptoms and frequent negative findings in the urine, sputum or blood culture. A recommended treatment of systemic BCG infection is long-term antimicrobial therapy with chinolones and antituberculotics including the corticosteroids. Current knowledge of complications of intravesical BCG therapy comes mainly from individual case reports. We report a case of the patient with miliary BCG-pneumonitis. The aim of this work is to increase awareness of disseminated disease as a complication of intravesical BCG immunotherapy, discuss the diagnostic methods and emphasise early antitubercular therapy even without the demonstration of viable bacteria or positive cultures.

Keywords: Bacillus Calmette-Guérin, disseminated pulmonary disease, bladder carcinoma, immunotherapy, Mycobacterium bovis.

Received: January 31, 2019; Accepted: March 26, 2019; Prepublished online: March 14, 2019; Published: June 20, 2019