MILIARY PNEUMONITIS AND INTRAVESICULAR BACILLUS CALMETTE-GUERIN TREATMENT

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bacillus Calmette-Guérin (BCG) is a live attenuated strain of the aerobic bacterium Mycobacterium bovis. Although mechanism action by which intravesical BCG elicits anti-tumorigenicity remains elusive, it mainstay adjunct treatment superficial bladder cancer. Non-infectious symptoms including dysuria, hematuria, and fevers are experienced in ~85% individuals treated. Disseminated mycoplasma infections reported less than 5% patients administered this intravesicular regimen. Most these involve genitourinary structures, but rarely BCG-associated pneumonitis can occur. CASE PRESENTATION: A 59 year-old gentleman presented to urology with gross hematuria. Cystoscopy biopsy revealed carcinoma situ poorly differentiated transitional cell carcinoma. Transurethral resection tumor was performed followed induction maintenance therapy monthly treatments BCG. The patient initially tolerated quite well, after two cycles developed an unexplained cough dyspnea associated night sweats. seven-day course levofloxacin prescribed for empiric presumed community acquired pneumonia (CAP). Unfortunately, patient's symptomatology recalcitrant CAP therapy. high-resolution CT chest demonstrated miliary tuberculosis. Tuberculin skin testing prior initiation found be negative. As guidance counselor, he worked alongside students fellow faculty at local high school. He had no recent international travel, incarceration, or any other risk factors TB. decision made administer isoniazid rifampin bovis origin. resolved following six-month aforementioned Follow up imaging improvement previously visualized ground glass opacities addition three subcentimeter pulmonary nodules remained. Surveillance additional six months showed resolution nodule stability. DISCUSSION: Pulmonary dissemination rare yet grave complication used recognition differentiation from tuberculosis essential appropriate pharmacologic intervention, especially since resistant some traditional drugs. CONCLUSIONS: This case explores critical features involved diagnosis pneumonitis. REFERENCE #1: Lamm DL. Complications bacillus immunotherapy. Urol Clin North Am. 1992 Aug;19(3):565-72. PMID: 1636240. #2: Ghandi NM, Morales A, Clamette-Gurin immunotherapy BJU int. 2013 Aug;112(3):288-97. doi: 10.1111/j.1464-410X.2012.11754.x. Epub Mar 20. 23517232 #3: Sylvester RJ, van der Meijden AP, Witjes JA, Kurth K. versus chemotherapy intravescal bladder: meta-analysis published results randomized clinical trials. J Urol. 2005 Jul;174(1):86-91; discussion 91-2. 10.1097/01.ju.0000162059.64886.1c. 15947584 DISCLOSURES: No relevant relationships Paul Dugdale, source=Web Response Daniel Santone,