Multiple organ failure and granulomatous hepatitis following intravesical bacillus Calmette-Guérin instillation

Abstract

Intravesical instillations of Bacillus-Calmette Guérin are widely used in the treatment of superficial bladder carcinoma. Although relatively safe, it has potentially lethal systemic side effects. In this case report a 68 year old patient presented with septic shock and multiple organ failure three days after instillation with Bacillus Calmette-Guérin. After treatment with fluid, vasopressors, broad spectrum antibiotics and antimycobacterial drugs the patient's condition improved. Ten days after admission there was a dramatic increase in bilirubin levels. A liver biopsy revealed granulomatous hepatitis. After the initiation of methylprednisolone the overall condition of the patient improved and serum bilirubin levels returned to normal.