Systemic BCGosis following intra-renal instillation of BCG: a case report

Abstract

Bacillus Calmette-Guerin (BCG) immunotherapy is a mainstay of adjunctive therapy for non-muscle-invasive bladder cancer. The instillation of BCG in the upper urinary tract after complete tumour eradication has also been studied and used after kidney-sparing management. It is effective in increasing the length of remission. However, it is also associated with rare but severe local and systemic side effects which may potentially become life-threatening. We present a case report of a 37-year-old gentleman who developed BCGosis following intra-renal instillation of BCG immunotherapy. The patient presented with systemic symptoms of jaundice, fever, myalgia and arthralgia, rather than local symptoms. Mycobacterium bovis infection was confirmed on blood cultures. The patient also developed hepatosplenomegaly, dyspnoea and pancytopaenia. BCGosis following intravesical instillation has been well documented in literature; to the best of our knowledge, this is the first case report documenting BCGosis following intra-renal instillation.

The Role of Local Agents for the Treatment of Localized Upper Tract Urothelial Carcinoma: A Review of the Current Evidence

“…Other severe AEs have been described, such as (febrile) kidney tubercolosis [ 15, 32 ], ureteral stenosis requiring ileal substitution of the ureter [ 32 ] and bladder contraction [ 42 ]. In 2021, Schembri Higgans J et al [ 57 ] reported the first case of systemic BCGosis following intra-renal instillation that required long-term antituberculartreatment.…”

Hemophagocytic syndrome in A patient of upper urinary tract urothelial cancer after Bacillus Calmette-Guérin instillation: A case report

“…Commonly observed adverse effects encompassed BCG-induced cystitis, bacterial infections, 14 increased urinary frequency, noticeable blood in the urine (frank hematuria), general discomfort (malaise), and fever. 15 , 16 Notably, a large cohort of 6753 patients, 1% developed BCG infections in the study period. 15 Another cohort of 418 patients, the incidence of severe complications was about 1.7%.…”

“… 15 , 16 Notably, a large cohort of 6753 patients, 1% developed BCG infections in the study period. 15 Another cohort of 418 patients, the incidence of severe complications was about 1.7%. 17 …”

Effect of Bacilli Calmette-Guerin vaccine on severe combined immunodeficiency patient: a narrative review and proposed workup algorithm

“…Steroids and anti TB therapy are frequently used in the treatment of BCGosis. 28,29 In individuals who have suspected BCGosis, it is critical to have a low threshold for initiating anti-TB therapy. 29 The majority of children with injection site problems and non-suppurative lymphadenitis responded completely within 6 months when treated conservatively.…”