Granulomatous hepatitis in a healthy adult after bacillus Calmette–Guérin injection into a plantar wart

V iral warts are a common skin disease that occurs in 7% to 10% of the entire population. In most cases, the warts disappear spontaneously within 2 years of their onset, but in about one-third of the cases, the warts recur despite repeated treatment. Treatment for warts includes salicylic acid, podophyllin, bleomycin, 5fluorouracil, laser therapy, interferons, cauterization, cryosurgery, and other surgical methods that usually cause pain and scarring. To treat warts by strengthening the immune response to the virus, a previous study reported that local immunotherapy in the form of a live bacillus CalmetteeGu erin (BCG) vaccine, an attenuated strain of Mycobacterium bovis injected within the wart, effectively treated the warts and inhibited relapse. There have been reports of erythema around the injection site, ulceration, and local lymphadenitis after BCG vaccination, but dissemination of M bovis after BCG injection is extremely rare, with an incidence of 0.008 to 0.1 per 100,000 vaccinations. Side effects of intralesional BCG injection in the wart are reported to be similar to those of BCG vaccines. According to a report by Lamm et al, intravesical injection of the BCG vaccine in patients with bladder cancer resulted in granulomatous hepatitis in 0.7% of cases. Granulomatous hepatitis with pneumonitis as a hypersensitivity systemic reaction after intravesical BCG was also reported, and all the symptoms in that case disappeared within a few days after steroid therapy. Such systemic complications of BCG inoculation are speculated to be caused by the dissemination of