VA Report: Infectious complications of intravesicular BCG instillation

Bacillus Calmette-Guerin (BCG) is a live attenuated strain of Mycobacterium bovis that is administered locally for treatment of superficial bladder cancer. It is usually well tolerated, but rarely, there can be infectious complications – both local and systemic.

The pathogenesis is not completely understood, but it is theorized that the organisms gain access to the lymphatics and blood via disrupted uroepithelium, with the potential to disseminate to multiple sites.

Severe adverse events due to instillation of BCG for bladder cancer are uncommon (less than 5%).

Local Disease:
1) A mild cystitis develops in the majority of patients after instillation of BCG.

Systemic Disease:
1) The most common severe systemic disease is a high fever (>39 degC), in ~3% of pts
2) Other systemic complications of BCG instillation include:
Sepsis syndrome
Granulomatous hepatitis
Pneumonitis (interstitial or military pattern)
Osteomyelitis
Arthritis

The diagnosis of a BCG-related reaction can be difficult to confirm, as the mycobacteria are not always seen on acid-fast smears or cultures.

Here is a great CPC from NEJM on the infectious complications of BCG.

BCG Complications_NEJM CPC_1998

 

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