Abstract Intravesical Bacillus Calmette–Guérin (BCG) therapy is a cornerstone in managing nonmuscle invasive bladder cancer. While generally well-tolerated, rare systemic complications, such as disseminated BCG infection, can occur. We report a case of a 72-year-old gentleman with bladder carcinoma treated with transurethral resection and intravesical BCG. He presented with bilateral lower limb edema, icterus, and fever. Investigations revealed hyponatremia, a cholestatic pattern of liver enzyme elevation, anemia, leukopenia, and hepatosplenomegaly. A liver biopsy confirmed granulomatous hepatitis, likely secondary to disseminated BCG infection. High-resolution computerized tomography of the chest showed a nonspecific interstitial pneumonia pattern and interstitial lung disease, supporting systemic dissemination. The patient was managed with antitubercular therapy, diuretics, statins, and supportive care, leading to symptomatic improvement. This case underscores the need for heightened clinical suspicion of disseminated BCG disease in patients developing systemic symptoms following intravesical instillations.
Yashwanth et al. (Thu,) studied this question.