A case of disseminated M. bovis bacillus Calmette-Guérin (BCG) disease after one month of BCG bladder infusion therapy and analysis of 77 cases of suspected BCG infection in Japan, 2017-2022

Masashi Nishimura; Masao Okumura; Takii Takemasa; Takashi Yoshiyama; Yoshiaki Tanaka; Mikio Saotome; Ken Ohta

doi:10.1016/j.rmcr.2023.101902

A case of disseminated M. bovis bacillus Calmette-Guérin (BCG) disease after one month of BCG bladder infusion therapy and analysis of 77 cases of suspected BCG infection in Japan, 2017-2022

Respir Med Case Rep. 2023 Jul 22:45:101902. doi: 10.1016/j.rmcr.2023.101902. eCollection 2023.

Authors

Masashi Nishimura^{1

2}, Masao Okumura¹, Takii Takemasa³, Takashi Yoshiyama¹, Yoshiaki Tanaka¹, Mikio Saotome¹, Ken Ohta¹

Affiliations

¹ Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan.
² Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan.
³ Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Japan.

Abstract

Bacillus Calmette-Guerin (BCG) intravesical injections are used as adjuvant therapy for superficial bladder cancer. We report a case of a 78-year-old man who developed disseminated M. bovis BCG disease mimicking miliary tuberculosis early after BCG intravesical infusion. He started coughing after receiving three rounds of BCG for superficial bladder tumors, following transurethral resection of the tumors, approximately one month after initiation. Computerized tomography (CT) images showed diffuse nodular shadows in the bilateral lung fields with a random pattern. Consequently, disseminated BCG disease was diagnosed. Treatment with isoniazid, rifampicin, and ethambutol was initiated. Nine months after initiating treatment, CT showed the disappearance of the miliary shadows. We also discussed 77 cases of suspected BCG infection and the requests for Mycobacterium bovis BCG identification at our institution from 2017 to October 2022. Of these, 76 cases were M. bovis BCG, and 1 case was M. tuberculosis. Since M. tuberculosis can be identified in some patients with suspected BCG infection, it is crucial to distinguish between the two based on pathogenicity.

Keywords: Bladder cancer; Miliary tuberculosis; Mycobacterium bovis BCG; Mycobacterium tuberculosis intravesical BCG.

Publication types

Case Reports