sions evident on both lower extremities were related to the presence antimycobacterial therapy points to an infectious process rather than a hypersensitivity reaction. A traumatic catheterization re-of leukocytoclastic vasculitis. Findings on examination of a bonemarrow aspirate and on chest radiographs and results of a urinalysis sulting in systemic BCG absorption, additional courses of BCG therapy notwithstanding intolerance symptoms, and delayed spewere normal. There was no proteinuria. Extensive investigations cific therapy may have furthered dissemination of BCG. revealed no signs of an underlying infectious or malignant disease, This case reaffirms the potential for major infectious complicaand disseminated infection with M. bovis was suspected. All cultures tions of bladder instillation of BCG in immunocompetent hosts of blood, bone marrow, sputum, and urine remained negative for [1]. BCG has proved to be more effective in the prophylaxis and Mycobacterium species. Histopathological evaluation of the bone treatment of superficial bladder tumors and carcinoma in situ than marrow and rectal ulcer revealed numerous nonnecrotizing granulomost chemotherapeutic agents [4]. A granulomatous reaction outmas with many epithelioid cells and giant cells. Special stains for side the urinary tract is rare, and pneumonitis or granulomatous mycobacteria, fungi, and bacteria were negative.hepatitis has been reported in only 0.9% of patients in large studies The patient received treatment with isoniazid (300 mg/d), ethambu-[1]. Recognition of risk factors, particularly traumatic catheterizatol (1,200 mg/d), and rifampin (600 mg/d). The patient's condition tion or concurrent cystitis, as well as the prompt treatment of improved within 1 week, and he was discharged. Purpura reappeared early side effects, should decrease the incidence of severe toxicity within 24 hours of exposure to cold. Purpuric lesions resolved within significantly. Our case illustrates that disseminated infection with 1 week and did not recur. When seen 3 and 6 months later, he was M. bovis after intravesical BCG instillation may be associated with completely well; findings on clinical examination and funduscopy cryoglobulinemia, monoclonal gammopathy, and an increase in and laboratory values were normal.the anticardiolipin antibody level. In our case, leukocytoclastic vasculitis was associated with cryoglobulinemia, monoclonal gammopathy, an elevated anti-J. M. Durand, C. Roubicek, F. Retornaz, E. Cretel, cardiolipin antibody level, and evidence of dissemination of BCG M. J. Payan, J. P. Bernard, G. Kaplanski, infection. The development of cryoglobulinemia has been deand J. Soubeyrand scribed during the course of different types of acute and chronic There have been only a few reports of cryoglobulinemia related to Mycobacterium tuberculosis infection [2, 3]. Cryoglobulinemia References has never been associated with M. bovis infection. Because we 1. Lamm DL, Van der Meijden APM, Morales A, et al. Incidence and treatment did not identify any chronic infla...
