Granulomatous Hepatitis Following Intra-Vesical Instillation of Bacillus Calmette-Guerin for Treatment of Bladder Cancer

Autores da FMUP

• António Carlos Megre Eugénio Sarmento

  Autor

Participantes de fora da FMUP

• Branco, EA
• Duro, R.
• Brito, T

Unidades de investigação

• Medicina

Abstract

Intra-vesical instillation of bacillus Calmette-Guerin (BCG) is an important treatment modality of superficial bladder cancer. It is usually well tolerated, although some adverse reactions can occur. One possible yet rare complication is granulomatous hepatitis, that is thought to be caused either by BCG infection or a hypersensitivity reaction to the bacillus. We present a case of a 79-year-old apparently immunocompetent patient who developed granulomatous hepatitis a few months after BCG administration for bladder cancer immunotherapy. It is important to notice that acid-fast smears and cultures are often negative, and these should not exclude diagnosis nor delay treatment. Our case highlights the importance of clinical suspicion and prompt initiation of appropriate treatment.

Keywords

• alanine aminotransferase; alkaline phosphatase; aspartate aminotransferase; BCG vaccine; gamma glutamyltransferase; hydroxymethylglutaryl coenzyme A reductase inhibitor; isoniazid; rifampicin; aged; alcohol consumption; anorexia; Article; body weight loss; cancer immunotherapy; case report; clinical article; computer assisted tomography; decreased appetite; dyslipidemia; echography; fatigue; granulomatous hepatitis; heart failure; heart muscle ischemia; hepatomegaly; hilar lymphadenopathy; histopathology; human; human tissue; liver biopsy; liver fibrosis; liver parenchyma; lung consolidation; lung emphysema; lung parenchyma; male; mediastinum lymphadenopathy; multinuclear cell; multiple pulmonary nodules; physical examination; splenomegaly; transitional cell carcinoma