Case report
Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy: Case report
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* Corresponding author: Claus J Fimmel cfimmel@lumc.edu
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
BMC Infectious Diseases 2011, 11:260 doi:10.1186/1471-2334-11-260
Published: 30 September 2011Abstract
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.