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Granulomatous hepatitis caused by Bacillus Calmette-Guerin (BCG) infection after BCG bladder instillation.
  1. F W Leebeek,
  2. R J Ouwendijk,
  3. A H Kolk,
  4. A Dees,
  5. J C Meek,
  6. J E Nienhuis,
  7. A M Dingemans-Dumas
  1. Department of Internal Medicine, Ikazia Hospital Rotterdam, the Netherlands.


    BACKGROUND--Bladder instillations with Bacillus Calmette-Guerin (BCG) are commonly used as immunotherapy for bladder carcinoma. Sometimes patients experience serious systemic side effects, such as sepsis or pneumonitis. Granulomatous hepatitis is a rare serious side effect, which has been considered a hypersensitivity reaction to BCG. PATIENT--The first case of granulomatous hepatitis after BCG bladder instillation in which mycobacteria were identified by staining techniques and mycobacterial DNA was detected in liver tissue using the polymerase chain reaction is reported. CONCLUSION--The granulomatous hepatitis was caused by BCG infection of the liver after haematogenous dissemination of BCG, rather than hypersensitivity.

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