Granulomatous balanitis after intravesical Bacille Calmette-Guérin instillation.

Transitional cell carcinoma of the bladder is an aggressive tumor with a high potential for malignant progression. Bacille Calmette-Guérin (BCG) has been used to treat malignant diseases for more than 20 years, and bladder cancer has been treated with it longer, since 1976. BCG is an attenuated strain of Mycobacterium bovis; instilled in solution to treat bladder cancer, it delays recurrence and prevents the implantation of tumor cells. Most patients tolerate intravesical irrigation with BCG well, but complications are not unusual. Side effects consist mainly of local irritation and flu-like symptoms and are usually mild. Various systemic and local infections have also been reported following instillation of BCG, which is a live organism. Such infections have included pneumonitis, hepatitis, granulomatous prostatitis, epididymitis, and renal parenchymal abscess. We present a case of granulomatous balanoposthitis that followed intravesical BCG therapy to prevent recurrence after transurethral resection of a transitional cell carcinoma. A 40-year-old man received intermittent cycles of intravesical BCG therapy to treat transitional cell carcinoma of the bladder starting in 2009. At 48 hours from the sixth instillation, which involved a difficult catheterization with slight extravasation of the product, the patient presented with yellowish papular lesions on the glans penis, large painful lymph nodes in the right groin, and dysuria (Fig. 1). A biopsy was performed and cultures were ordered. In the differential diagnosis, we considered infectious diseases (herpetic primo-infection, syphilis, fungal infection, skin infection due to BCG) and neutrophilic diseases (pyoderma gangrenosum, Behçet disease).