Disseminated Bacillus Calmette-Guérin (BCG) infection presenting as severe respiratory failure and septic shock

• DOI: 10.18683/germs.2023.1395
• Publication Date: 2023-11-26T21:21:10Z
• Authors: Diamantina Marouli; Evmorfia Kondili; Charalampos Pappas; Maria Raissaki; Eleftherios Papad...
• Keywords: Pneumonitis

Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective adjuvant therapy for superficial urinary bladder carcinoma, prolonging disease-free survival. Although it usually well tolerated, moderate to severe local or systemic infectious complications, including sepsis involving multiple organs, may occur.We report unusual case of a man in his mid '70s who presented with septic shock and acute respiratory failure requiring intubation. Lack response antibiotics, history intravesical BCG consistent imaging findings led further investigations, bronchoalveolar lavage (BAL) fluid polymerase chain reaction (PCR) results indicating pneumonitis due Mycobacterium bovis dissemination. Prompt anti-tuberculosis treatment combined corticosteroids resulted significant clinical radiological improvement, supporting diagnosis disseminated infection.Due its non-specific presentation relatively low diagnostic yield conventional microbiological tests, high index suspicion required prompt infection. PCR-based assays mycobacterial DNA identification represent valuable tool facilitating timely this uncommon, yet potentially life-threatening