Culture-proven disseminated Mycobacterium Bovis infection (BCG-Osis) following intravesical BCG immunotherapy in a patient with bladder carcinoma-in-situ: ‘Case report’

Urogenital infection with M. bovis BCG most probably as a result of BCG instillation 21 years ago

We present the case of a man in his late 70s who developed urogenital infection with M. bovis BCG most probably following BCG instillation for bladder cancer, a surprising 21 years after the BCG treatment had ended.The patient presented with an indolent testicular swelling initially presumed to be testicular cancer. After surgical exploration, the swelling proved to be a M. bovis BCG-infected granuloma. Treatment consists of ethambutol, rifampicin and isoniazid over several months, which can cause severe side effects.We conclude that any unclear lesion or tumour in a patient who has had BCG instillation should be tested for mycobacteria along standard histological and microbiological analyses.

BCG-osis: a complication after intravesical BCG immunotherapy

BCG, or live attenuated Mycobacterium bovis, intravesical immunotherapy is now an established component of the standard of care for bladder cancer following transurethral resection of bladder tumour. The following case demonstrates the rare complication of disseminated BCG (BCG-osis) that may arise after the aforementioned therapy. Patients at increased risk of this complication include those who are immunocompromised, above the age of 70 and patients who have had traumatic catheterisation. Diagnosis can be made with or without microbiology and management includes a multidrug regimen. It is important to recognise the signs and symptoms of BCG-osis and postpone future intravesical instillation of BCG if there is traumatic catheterisation. Future instillation should be completely discontinued if a patient develops disseminated M. bovis.