Indications

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

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Pharmacology

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

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Administration

• Intravesical: xxx

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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

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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