Bacillus Calmette-Guerin (BCG), a live attenuated form of Mycobacterium bovis (M. bovis), is the most effective intravesical agent in the treatment of non-invasive bladder cancer. This therapy can cause minor complications like urinary frequency, fever, dysuria and hematuria, but it can also cause more serious systemic complications such as hepatitis, pneumonitis and sepsis. Miliary tuberculosis is a very rare complication of BCG immunotherapy and is associated to high mortality, thus this diagnosis must be early considered and early treatment should be implemented. The authors report a case of miliary tuberculosis after treatment with intravesical BCG, with isolation of M. bovis. The patient presented clinical and imaging improvement after initiation of tuberculostatic agents.

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