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. 2011 Mar 27;3(3):79-82.
doi: 10.4254/wjh.v3.i3.79.

Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation

Michail Kaklamanos  1 , Georgia Hardavella, Rodoula Trigidou, Georgios Dionellis, Nikolaos Paissios, Nikolaos Koulouris, Constantin Goritsas
Affiliations

Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation

Michail Kaklamanos et al. World J Hepatol. .

Abstract

Bacillus Calmette-Guerin (BCG) intravesical instillation has been adopted in the treatment of patients with superficial bladder cancer. BCG-induced disseminated infection, though rare, has been associated with the histological finding of epithelioid granulomas in different organs, including the liver. We report the case of an adult patient with multi-organ failure, who developed sepsis, acute respiratory failure and acute hepatic failure with encephalopathy whose liver biopsy confirmed the presence of atypical, granulomatous-like lesions. Recovery was observed only after empirical therapy for Mycobacterium bovis with isoniazid, rifampicin, ethambutol and steroids was introduced. This case highlights the importance of a thorough patient assessment in order to exclude other more common causes of hepatic granulomas and to confirm diagnosis. Histological findings may be non-specific when the liver is involved in BCG-induced disseminated infection.

Keywords: Bacillus Calmette-Guerin; Hepatic granulomas; Multi-organ failure; “Bacillus Calmette-Guerin-itis”.

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Figures

Figure 1
Figure 1
Timescale of liver biochemistry deterioration. AST: aspartate aminotransferase (nr:10-37 IU/L); ALT: alanine aminotransferase (nr: 10-37 IU/L); ALP: alkaline phosphatase (nr: 34-104 IU/L); LDH: lactate dehydrogenase (nr: 135-225 IU/L); γ-gt: γ-glutamyl transferase (nr: 9-40 IU/L); nr: normal range.
Figure 2
Figure 2
Small granulomatous-like lesions (coarse arrows), including his­ti­ocytes (fine arrow), in liver FNB material stained with Hematoxylin and Eo­s­in. A: × 100; B: × 400. FNB: fine needle biopsy.
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