Disseminated BCG-osis and the Importance of Performing Post-Mortem Examinations

Bacillus Calmette-Guerin (BCG) is a live-attenuated strain of Mycobacterium bovis (M bovis), originally developed as a vaccine against tuberculosis. It is also used in the treatment of bladder cancer. We present a case of disseminated BCG-osis which was only discovered at post-mortem. An 89-year-old male was admitted to a tertiary referral centre in inner Sydney in December 2015 with fevers, night sweats, exertional dyspnoea and 8 kg weight loss. The patient developed progressive type 1 respiratory failure requiring non-invasive positive pressure ventilation and treatment for heart failure, but he died eleven days into his admission. On microbiological testing Mycobacterium. tuberculosis complex (MTBC) DNA was detected in lung tissue, by polymerase chain reaction (PCR), using the Xpert MTB/RIF (Cepheid) platform, the day after the patient's death. Later mycobacterial culture and genomic deletion analysis identified the specific organism as M bovis. This report describes an unusual presentation of systemic BCG-osis appearing more than three years after the last BCG instillation. This reinforces the fact that BCG instillation of the bladder for transitional cell carcinoma poses a potential risk of systemic spread even years after.