Bacillus Calmette-Guerin (BCG)

Indications

Superficial Bladder Cancer (see Bladder Cancer, [[Bladder Cancer]]): intravesical BCG

Pharmacology

Bacillus Calmette-Guerin (BCG): an attenuated strain of bovine tuberculous bacterium and consists of living bacilli, dead microorganisms, and subcellular debris

Administration

Intravesical: xxx

Adverse Effects

Pulmonary Adverse Effects

Disseminated BCG Infection

Clinical
- Focal Pneumonia (see Pneumonia, [[Pneumonia]])
- Empyema (see Pleural Effusion-Exudate, [[Pleural Effusion-Exudate]])
- Cavitary Infiltrates (see Cystic-Cavitary Lung Lesions, [[Cystic-Cavitary Lung Lesions]] and Tuberculosis, [[Tuberculosis]]): mimicking TB

Granulomatous Pneumonitis (see Interstitial Lung Disease-Etiology, [[Interstitial Lung Disease-Etiology]])

Epidemiology: occurs in <1% of cases
Clinical: fever, chills, night sweats, malaise, dyspnea, cough
Diagnosis
- Chest CT: miliary or 2-8 mm nodular pattern (may have mediastinal + hilar lymphadenopathy)
- FOB-TBB: caseating or non-caseating granulomas

Hypersensitivity Pneumonitis (see Hypersensitivity Pneumonitis, [[Hypersensitivity Pneumonitis]])

Diagnosis
- CXR/Chest CT: interstitial infiltrates
- FOB-BAL: alveolar lymphocytosis with increased T4/T8 ratio
Treatment: favorable response to steroids

Acute Lung Injury (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])

xx

Other Adverse Effects

xxxx

References

Granulomatous Pneumonitis Following Intravesical BCG, What Therapy Is Needed? Chest 1994;106:1624-26
Granulomatous Chest Disease Following Intravesical Bacillus Calmette-Guerin Immunotherapy. J Thorac Imaging • Volume 19, Number 1, January 2004
Hypersensitivity Pneumonitis Following Intravesical Bacille Calmette-Guérin Immunotherapy for Superficial Bladder Cancer. J Investig Allergol Clin Immunol 2009; Vol. 19(3): 230-232