Guillain Barré syndrome associated with bladder instillation of Bacille Calmette Guérin (BCG)

• DOI: 10.1099/jmmcr.0.005164
• Publication Date: 2018-08-20T16:12:41Z
• Authors: Karmel Webb; Pradhib Venkatesan
• Keywords: myalgia

Guillain Barré Syndrome (GBS) has rarely been associated with tuberculosis and previously reported after Bacille Calmette Guérin (BCG) vaccination, but we report an association of GBS intra-vesical BCG instillations followed by the clinical picture disseminated BCGosis.A 68-year-old man bladder carcinoma had a transurethral tumour resection repeated instillations. Catheterization for his eighth dose was traumatic, causing frank haematuria. Ten days later he presented fevers, myalgia dyspnoea. Chest X-ray on admission showed micronodular shadowing computed tomography scan miliary changes in lungs. Disseminated BCGosis infection suspected symptoms did improve starting rifamipicin, isoniazid ethambutol. Over 2 weeks post-admission developed unsteady gait, reduced pin-prick sensation below both knees fingertips, proprioception toes ankles, absent reflexes lower limbs diminished upper limbs. Nerve conduction studies purely demyelinating sensori-motor peripheral neuropathy limbs, characteristic GBS.To our knowledge this is first case following instillation BCG. Given millions cases doses administered BCG, must be very rare adverse effect.