Introduction: Intravesical administration of Bacillus Calmette -Guerin (BCG) is a routine adjuvant treatment option for non-muscle invasive bladder cancer (NMIBC) following Trans Urethral Resection of the Bladder Tumour (TURBT). This patient was referred to the local Urology service by his GP with persistent microscopic haematuria.
Clinical Findings, Treatment and Outcome: The patient underwent ultrasound imaging and flexible cystoscopy and was found to have a suspicious lesion which was graded histologically as G3pTa TCC with associated CIS. He was commenced on intravesical BCG therapy. He was subsequently admitted multiple times with night sweats, fevers and rigors. There were initial presumptions of repeated urinary tract infections, however, a clinical response was not observed with antibiotic treatment regimens. His case was discussed amongst medical, urological and microbiology teams who concluded the patient’s symptoms to be the result of a systemic BCG reaction. He was started on a long course of anti-TB medications. He was then further trialled, unsuccessfully, on intravesical mitomycin. Unfortunately, palliative chemotherapeutic and immunological therapies were also exhausted. The disease continued to progress with metastasis, and the patient, ultimately, did not survive the ordeal.
Discussion: The exact nature of BCGosis has been an article of debate, with some theorising that multiple negative culture results lends itself to the argument that systemic effects of BCGosis are the result of a type IV hypersensitivity reaction to the presence of BCG, rather than systemic spread and organ infiltration by the bacteria. There is no consensus of the treatment of systemic spread of BCG in such cases.
