Abstract
The development of granulomatous lesions in distant organs is an uncommon complication of the immunotherapy with BCG vaccine. We report a case of granulomatous hepatitis after the 12th BCG intravesical instillation (6 weekly followed by 6 monthly) in a 58-year-old man with superficial bladder cancer. The patient was admitted because of fever and jaundice. Disseminated BCG infection was suspected on the basis of history, clinical examination and a liver biopsy that showed noncaseating granulomatous hepatitis. PCR for M. bovis was positive in the liver tissue, confirming the mycobacterial dissemination. Our patient improved clinically with a regimen including both corticosteroids and antituberculosis agents.
MeSH terms
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Administration, Intravesical
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Adrenal Cortex Hormones / therapeutic use
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Animals
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Antitubercular Agents / therapeutic use
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BCG Vaccine / administration & dosage
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BCG Vaccine / adverse effects*
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Carcinoma, Transitional Cell / therapy
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Cattle
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Drug Therapy, Combination
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Granuloma / microbiology*
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Granuloma / pathology
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Humans
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Liver / microbiology
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Liver / pathology
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Male
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Middle Aged
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Mycobacterium Infections / complications*
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Mycobacterium Infections / drug therapy
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Mycobacterium bovis / isolation & purification*
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Polymerase Chain Reaction
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Treatment Outcome
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Tuberculosis, Hepatic / drug therapy
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Tuberculosis, Hepatic / microbiology*
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Urinary Bladder Neoplasms / therapy
Substances
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Adrenal Cortex Hormones
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Antitubercular Agents
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BCG Vaccine