Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy: Case report

BMC Infect Dis. 2011 Sep 30:11:260. doi: 10.1186/1471-2334-11-260.

Abstract

Background: Intravesical instillation of Bacillus Calmette-Guérin (BCG) is the treatment of choice for superficial bladder carcinoma. Complications of BCG therapy include local infections and disseminated BCG infection with multiple endorgan complications.

Case presentation: We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis. After successful anti-mycobacterial therapy and resolution of the hepatic and ocular abnormalities, the patient developed an acute upper gastrointestinal hemorrhage from an aortoduodenal fistula that required emergency surgery. The resection specimen revealed multifocal, non-caseating granulomas, indicating mycobacterial involvement.

Conclusions: This case highlights the varied end organ complications of disseminated BCG infection, and the need for vigilance even in immuno-competent patients with a history of intravesical BCG treatment.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravesical
  • Antitubercular Agents / administration & dosage
  • Aorta / pathology
  • Biological Products / administration & dosage
  • Biological Products / adverse effects*
  • Carcinoma / therapy
  • Choroiditis / complications
  • Choroiditis / diagnosis*
  • Choroiditis / microbiology
  • Choroiditis / pathology
  • Duodenum / pathology
  • Fistula / complications
  • Fistula / diagnosis*
  • Fistula / microbiology
  • Fistula / pathology
  • Gastrointestinal Hemorrhage / complications
  • Gastrointestinal Hemorrhage / diagnosis*
  • Gastrointestinal Hemorrhage / microbiology
  • Gastrointestinal Hemorrhage / pathology
  • Granulomatous Disease, Chronic / complications
  • Granulomatous Disease, Chronic / diagnosis*
  • Granulomatous Disease, Chronic / microbiology
  • Granulomatous Disease, Chronic / pathology
  • Hepatitis / complications
  • Hepatitis / diagnosis*
  • Hepatitis / microbiology
  • Hepatitis / pathology
  • Humans
  • Male
  • Middle Aged
  • Mycobacterium bovis / immunology
  • Mycobacterium bovis / pathogenicity*
  • Treatment Outcome
  • Urinary Bladder Neoplasms / therapy

Substances

  • Antitubercular Agents
  • Biological Products