Open Access Highly Accessed Case report

Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy: Case report

Cindy Q Gao1, Rozina Mithani1, Jack Leya14, Lesley Dawravoo1, Arvin Bhatia1, John Antoine25, Felipe De Alba36, Peter A Russo36 and Claus J Fimmel14*

Author Affiliations

1 Division of Gastroenterology, Hepatology and Nutrition, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL 60153, USA

2 Department of Pathology, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL 60153, USA

3 Department of Ophthalmology, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL 60153, USA

4 Gastroenterology Section, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA

5 Pathology Section, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA

6 Ophthalmology Section, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA

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BMC Infectious Diseases 2011, 11:260  doi:10.1186/1471-2334-11-260

Published: 30 September 2011

Abstract

Background

Intravesical instillation of Bacillus Calmette-Guérin (BCG) is the treatment of choice for superficial bladder carcinoma. Complications of BCG therapy include local infections and disseminated BCG infection with multiple endorgan complications.

Case Presentation

We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis. After successful anti-mycobacterial therapy and resolution of the hepatic and ocular abnormalities, the patient developed an acute upper gastrointestinal hemorrhage from an aortoduodenal fistula that required emergency surgery. The resection specimen revealed multifocal, non-caseating granulomas, indicating mycobacterial involvement.

Conclusions

This case highlights the varied end organ complications of disseminated BCG infection, and the need for vigilance even in immuno-competent patients with a history of intravesical BCG treatment.