Genitourinary Bacillus Calmette-Guerin Infection after BCG Intravesical Administration in a Patient under Hemodialysis — What Can We Do Better?

A 74-year-old man with terminal chronic kidney disease, under hemodialysis and residual diuresis, was admitted due to myalgia, arthralgia, fever pyuria in the previous 10 days. The patient had a recent diagnosis of high-grade non-invasive bladder cancer doing weekly BCG intravesical administrations. symptoms started three days before fifth administration. He done cefixime as an outpatient piperacillin-tazobactam on hospital admission, but persisted, there no bacterial isolation urine or blood culture. On tenth seventeenth day after last administration Mycobacterium bovis still isolated BCGitis made treatment started, good response. Forty treatment, culture remained positive for urine. We raise question about safety patients diuresis.