BCGitis: A rare complication after intravesical BCG therapy

In most cases, bladder carcinoma is located superficially, and the therapeutic approach is usually transurethral resection followed by intravesical therapy (chemotherapy or immunotherapy).(1,2) Initially produced as a vaccine against tuberculosis, BCG—an attenuated strain of Mycobacterium bovis—has been widely used in immunotherapy over the last decades.(1,3) Although BCG, used as immunotherapy, has not produced the best results in many cancers, it has been clinically successful in the intravesical treatment of superficial bladder carcinomas.(4) Immunotherapy with intravesical BCG eradicates the residual tumor, slows the progression of the disease, reduces the need for cystectomy, and prolongs survival.(4) Treatment with BCG is well tolerated by over 95% of patients. The most common side effects are local (inflammation, fever, and pelvic adenopathy). However, although rare, systemic complications have been described.(1,3-6) Systemic dissemination of the attenuated M. bovis bacillus is known as BCGitis. It is more common in individuals with underlying primary or secondary immunodeficiency but can occur in immunocompetent patients.(1,6) There have been only a few reports of cases of respiratory BCGitis.(1,2,6) Here, we report the case of a patient who was treated with local BCG immunotherapy for urothelial bladder carcinoma and developed a severe M. bovis respiratory infection.