Endophthalmitis in a Patient Treated With Bacillus Calmette-Guérin Immunotherapy

Abstract

This case highlights the direct choroidal mycobacterial infection of the disease after BCG instillations for bladder cancer and failure of treatment despite culture-proven drug sensitivity, thus suggesting the need to revaluate adequate treatment to avoid loss of vision.

Ocular adverse events following vaccination: overview and update

“…There was one case of Mycobacterium bovis endophthalmitis following intravesical bacillus Calmette-Gue ˊrin (BCG) for the treatment of cancer. 109 The intraocular organism was the same genetically as the BCG bacillus, confirming the source of infection. Three other cases of uveitis and periocular inflammation following intravesical administration of BCG were reported as sterile.…”

Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

“…There are 15 cases of ocular inflammation after intravesical BCG instillations in the literature. Although cross-reactivity and immunologic reactions are possibly implicated in uveitis after BCG instillations, culture-positive M. bovis endophthalmitis was reported in 4 cases which confirmed a direct vitreous invasion after hematogenous dissemination of the microorganism [63]. These cases highlighted a poor ocular outcome despite of an adequate systemic anti-TB therapy, and intravitreal therapy targeted toward M. bovis or additional therapy may be required.…”

Bacille Calmette-Guérin: An ophthalmic perspective

“…In a study of 256 subjects treated with IBCG, 4.3% had disseminated systemic infection 110 , and localized ocular involvement was seen in 9% subjects. Culture-positive M. bovis endophthalmitis has been reported in eight eyes of five cases, which confirmed a direct vitreous invasion after hematogenous dissemination of the microorganism 43 , 48 , 55 , 68 , 79 , 138 . The first case, reported by Lester and coworkers, was a 66-year-old patient with bilateral endophthalmitis with a proven reduction in the size of retinal lesions with antitubercular therapy before the patient's death 68 .…”

“…The third case reported by Gerbrandy had a severe vitritis complicated by serous detachment and multiple choroidal granulomatous lesions 43 . Vadboncoeur and coworkers described another unilateral case with significant vitritis and vitreous condensation as well as a fluffy granulomatous retinal mass 138 . In this case, the real-time polymerase chain reaction for mycobacteria was positive.…”