[BCGitis with Involvement of Lung, Liver and Bone Marrow after Immunotherapy of Urothelial Cancer].

Medical history  A 77-year-old patient with transurethral resection of a bladder tumor was transferred due to persistent fever and progressive dyspnea despite antibiotic therapy for suspected urinary tract infection. Repeating the medical history revealed that a BCG immunotherapy of his non-muscle-invasive bladder carcinoma was performed the day before fever developed. Therefore, BCGitis was suspected. Examinations  Laboratory parameters showed pancytopenia, elevated liver enzymes, eleveated C-reactive protein and hypoxemia. The CT scan showed multiple miliary lesions of the lung, the bone marrow biopsy revealed granuloma. Diagnosis  M. bovis BCG was cultured from urine and bronchoalveolar lavage fluid. Therapy and course  Therapy with isoniazide, rifampine, ethambutol and initially prednisolone caused rapid improvement. Conclusion  BCGitis is a rare complication of BCG immunotherapy of non-muscle-invasive bladder carcinoma.