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
Adverse Effects
Pulmonary Adverse Effects
Disseminated BCG Infection
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]])
Other Adverse Effects
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