Mycobacterial sepsis following intravesical instillation of Bacillus Calmette-Guerin

Intravesical bacillus Calmette-Guerin (BCG) administration for bladder cancer may lead to BCG dissemination in the compromised host. A case of a 63-year-old man with shock secondary to BCG sepsis is reported. The recognition and treatment of disseminated BCG infection are discussed. In addition to standard therapy for urosepsis, early therapy with steroids and coverage with antitubercular medications should be initiated for patients with this condition. In general, the author recommends that all febrile patients who have received BCG immunotherapy within three years, and who have no obvious source for their fever, have acid-fast bacilli blood cultures done for Mycobacterium bovis, and that these patients be admitted to the hospital for further evaluation.