When the cure is worse than the disease: the role of the internist in post-immunotherapy complications
DOI:
https://doi.org/10.32818/reccmi.a11n2a15Keywords:
mycobacterium bovis, BCG, immunotherapy, disseminated BCG infectionAbstract
Intravesical bacillus Calmette–Guérin (BCG) is the adjuvant treatment of choice for non–muscle-invasive bladder
cancer, although it can rarely cause systemic infection (BCGitis). We present the case of a 74-year-old man with
urothelial bladder carcinoma treated with transurethral resection and Bacillus Calmette-Guérin (BCG) instillations,
who developed septic shock with multiorgan failure after an instillation. Cultures and microbiological tests were
negative. During the course, he presented persistent cholestasis and a ground-glass pulmonary pattern. Liver biopsy showed non-necrotizing granulomas, confirming the diagnosis of systemic BCGitis with hepatic and pulmonary
involvement. Treatment is based on antimycobacterial therapy and corticosteroids, as well as suspension of
BCG treatment.
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Copyright (c) 2026 Cayetana Echeverría-López, Sílvia Briansó-Caballero, Alba Mohedano-Sánchez, Balma Homedes-Pedret, Joan Duran-Bertran
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