Histopathology of Disseminated Mycobacterium bovis Infection Complicating Intravesical BCG Immunotherapy for Urothelial Carcinoma

Brandon Larsen, Maxwell L. Smith, Thomas Grys, Holenarasipur R. Vikram, Thomas V. Colby

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Intravesical instillation of Bacillus Calmette-Guérin (BCG) is a mainstay of adjunctive therapy for superficial bladder cancer. Disseminated BCG infection ("BCG-osis") after this therapy is rare and potentially life-threatening; only isolated case reports detail the histopathologic findings thereof, few of which had a diagnosis confirmed by molecular testing. We report 3 additional cases of BCG-osis complicating BCG therapy, all confirmed by cultures and molecular assays, including the first cases of wedge biopsy-confirmed BCG pneumonia and BCG olecranon bursitis. When suggested by a relevant clinical history, recognition of randomly distributed granulomas in any organ should prompt consideration of BCG-osis and liberal performance of AFB stains, aided by targeted molecular assays. Physicians should maintain a high index of suspicion when miliary infiltrates arise after intravesical BCG instillation, and close multidisciplinary communication is essential. Pathologist awareness of this rare cause of granulomatous inflammation aids recognition of BCG-osis and facilitates prompt initiation of antimycobacterial therapy.

Original languageEnglish (US)
Pages (from-to)189-195
Number of pages7
JournalInternational Journal of Surgical Pathology
Volume23
Issue number3
DOIs
StatePublished - May 4 2015

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Keywords

  • Bacillus Calmette-Guérin
  • granulomatous hepatitis
  • granulomatous pneumonia
  • Mycobacterium bovis
  • urothelial carcinoma

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

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