- Intravesical BCG instillation is first line in superficial bladder carcinoma.
- It has been shown to delay the time to the first recurrence after transurethral resection of the bladder tumor and to reduce the risk of progression to muscle invasive disease.
- Mechanism is unclear, probably related to local immune responses.
- A rare adv effect is disseminated M.bovis infection.
- Radiographically, present as GGO.
- Histopathologically, granulomas are uniformly present in all forms of disseminated BCG disease, usually a caseating one.
- Culture takes time but normally culturing the involved tissues will yield positive result.
- Suggested treatment approach:
– Treat symptomatically if the symptoms are mild or <2 days.
– Pyrazinamide is NOT recommended due to resistance. Otherwise, treatment resembles that of TB treatment
– M.bovis can cause hypersens.pneumonitis. A corticosteroid course can be added in severe disease.
Josalyn L. Cho, M.D., Shaunagh McDermott, M.D., Athe M. Tsibris, M.D.,
and Eugene J. Mark, M.D. Case 37-2015: A 76-Year-Old Man with Fevers, Leukopenia, and Pulmonary Infiltrates. N Engl J Med 2015;373:2162-72
Krisztina A. Nadasy, MD; Rikin S. Patel, MD; Michael Emmett, MD, MACP; Ricardo A. Murillo, MD; Marc A. Tribble, MD; Robert D. Black, MD; William L. Sutker, MD. Four Cases of Disseminated Mycobacterium bovis Infection Following Intravesical BCG Instillation for Treatment of Bladder Carcinoma. South Med J. 2008;101(1):91-95.