CHEST Guidelines-An-80-Year-Old-Man-With-Respiratory-Insufficiency-

An-80-Year-Old-Man-With-Respiratory-Insufficiency-

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An 80-year-old man with a history of superficial bladder cancer treated with intravesical Mycobacterium bovis BCG immunotherapy presented to the emergency department with fever, hematuria, and discomfort. Initially suspected of having a urinary tract infection, he was treated with antibiotics, but his condition did not improve. He developed hypoxemic respiratory failure accompanied by fever and chills, necessitating admission to the ICU where he was intubated and mechanically ventilated.<br /><br />Diagnostic tests revealed elevated inflammatory markers and liver enzymes. Chest imaging showed diffuse infiltrates and ground-glass opacities in his lungs, which, combined with his poor response to antibiotics and a history of BCG treatment, led to the suspicion of disseminated BCG infection, also known as BCGitis. Cultures eventually confirmed the presence of M. bovis BCG.<br /><br />BCGitis can occur as a rare complication of BCG immunotherapy for bladder cancer, potentially leading to systemic symptoms such as fever, respiratory distress, and organ involvement. Its cause may involve both hypersensitivity and active infection. Treatment typically involves corticosteroids and antituberculosis drugs.<br /><br />In this case, the patient was treated with rifampicin, isoniazid, ethambutol, and prednisolone, and later shifted to a tailored antituberculosis regimen once strain sensitivity was analyzed. Over 11 months, the patient experienced clinical improvement, was able to return home, and showed normalized radiological findings. This case highlights the importance of recognizing BCGitis symptoms and initiating timely treatment to prevent severe outcomes, such as respiratory failure or organ failure. It also emphasizes the role of interdisciplinary medical discussions in managing complex cases.

Keywords

BCGitis

bladder cancer

Mycobacterium bovis

immunotherapy

respiratory failure

disseminated infection

antituberculosis drugs

corticosteroids

interdisciplinary management

ground-glass opacities