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Case Reports
. 2025 May 30;13(6):1283.
doi: 10.3390/microorganisms13061283.

Central Nervous System Infections Caused by Bacillus Calmette-Guerin: Case Report and Narrative Literature Review

Davide Chemello  1 , Maddalena Albertini  1 , Johanna Chester  2 , Sara Esperti  1 , Elena Ghidoni  1 , Gabriella Orlando  1 , Giacomo Franceschi  1 , Corrado Iaccarino  3   4   5 , Lucio Lucchesi  3 , Giacomo Pavesi  3   4   5 , Cristina Mussini  1 , Erica Franceschini  1
Affiliations
Case Reports

Central Nervous System Infections Caused by Bacillus Calmette-Guerin: Case Report and Narrative Literature Review

Davide Chemello et al. Microorganisms. .

Abstract

Bacillus Calmette-Guerin (BCG) central nervous system (CNS) infections are one of the rarest complications following BCG exposure. A 77-year-old male, with bladder cancer previously treated with BCG instillation, presented with fever, confusion, and brain magnetic resonance imaging (MRI) consistent with encephalitis one month after the last BCG instillation. Cerebrospinal fluid (CSF) showed marked hypoglycorrhachia, hyperproteinorrachia, and lymphocytic pleocytosis. Despite CSF culture negativity, the presentation was considered suggestive of BCG-related encephalitis, and the empirical standard antitubercular treatment (rifampin, isoniazid and ethambutol), plus dexamethasone, was initiated. Following initial improvement, gait ataxia and hemiplegia were observed at the 4-month follow-up. MRI revealed an excluded enlarged left lateral ventricle with signs of ventriculitis, requiring surgical drainage. CSF collected during neurosurgery resulted positive on PCR for M. tuberculosis complex. Adjunctive linezolid was initiated, replaced by levofloxacin due to adverse events after 2 weeks. The patient was discharged following a normal CSF analysis. Oral antitubercular therapy was prescribed for 14 months and there were no signs of relapse at the 24-month follow-up. Previously, 16 cases of CNS BCGitis have been reported, without any cases of clinical relapse during antitubercular treatment. Furthermore, our study reports the use of linezolid as a 4th antitubercular drug for CNS BCGitis.

Keywords: Bacillus Calmette–Guerin; M. bovis; encephalitis; ventriculitis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
First MRI in FLAIR sequence showing vasogenic edema of the temporal lobe.
Figure 2
Figure 2
MRI in T1 sequence, with gadolinium contrast enhancement, showing an enlarged left lateral ventricle * and contrast uptake of the excluded ventricle **.
Figure 3
Figure 3
Endoscopic image showing synechiae found in the left excluded ventricle.
Figure 4
Figure 4
CT scan showing the resolution of hydrocephalus after endoscopic septostomy and placement of Ommaya drain.
Figure 5
Figure 5
CNS BCGitis management flowchart.
See this image and copyright information in PMC

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