Fatal Outcome Due to Sepsis by Mycobacterium Bovis Six Years After BCG Intravesical Instillations

Abstract

Bacillus Calmette-Guerin (BCG) in intravesical instillations is the reference treatment for urothelial carcinoma with a high risk of progression. Morbidity secondary to intravesical BCG may present both locally and systemically. Most patients suffer a self-limited irritative voiding syndrome. Prevention of these complications requires implementing rules of good practice for the instillations. The undesirable side effects should be recognized early. Their treatment should be rapid and adapted to the patient. Besides the commonly seen side effects of intravesical BCG instillations, very rare complications have been reported. In some patients, infection appears early (within 3 months after instillation) and is characterized by generalized symptoms, with pneumonitis and hepatitis. Late-presentation disease occurs more than 1 year after the first BCG treatment and usually involves focal infection of the genitourinary tract (the site at which bacteria were introduced) and/or other sites that are typical for reactivation of mycobacterial disease, such as the vertebral spine or the retroperitoneal tissues. Non caseating granulomas are found in the majority of cases, whether early or late. Most patients respond to treatment with antituberculous drugs; in early-presentation disease, when features of hypersensitivity predominate, glucocorticosteroids are sometimes added. Late localized infection often requires surgical resection.