Gram-negative sepsis and granulomatous cholestatic hepatitis following intrarenal instillation of BCG: a case report and narrative review

Abstract Background BCG immunotherapy is the most widely used therapy for non-muscle invasive urothelial carcinomas. It is well-tolerated by majority of patients, but in some cases serious complications can occur. Case presentation A 68-old woman was treated with BCG due to bilateral ureteral CIS. After the first BCG instillation she developed gram negative sepsis and cholestatic BCG-hepatitis that progressed to acute liver and respiratory failure. She was successfully treated with anti-TB therapy and adjuvant systemic corticosteroids. Conclusion The timely recognition and appropriate treatment of systemic BCG complications is essential for the achievement of favorable outcome.