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GERMS
Volume 13
Issue 3
10.18683/germs.2023.1395
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GERMS is published by MDPI from Volume 25 Issue 4 (2025). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with the former publisher Infection Science Forum S.R.L..
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Case Report

Disseminated Bacillus Calmette-Guérin (BCG) Infection Presenting as Severe Respiratory Failure and Septic Shock

by
Diamantina Marouli
1,*,
Charalampos Pappas
1,
Maria Raissaki
2,
Athanasia Proklou
1,
Eleftherios Papadakis
1 and
Eumorfia Kondili
1
1
Department of Intensive Care, University Hospital Heraklion, Panepistimiou Avenue, 71110 Heraklion, Crete, Greece
2
Department of Radiology, University Hospital Heraklion, Panepistimiou Avenue, 71110 Heraklion, Crete, Greece
*
Author to whom correspondence should be addressed.
GERMS 2023, 13(3), 277-281; https://doi.org/10.18683/germs.2023.1395
Submission received: 23 May 2023 / Revised: 17 August 2023 / Accepted: 31 August 2023 / Published: 30 September 2023
Versions Notes

Abstract

Introduction: Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective adjuvant therapy for superficial urinary bladder carcinoma, prolonging disease-free survival. Although it is usually well tolerated, moderate to severe local or systemic infectious complications, including sepsis involving multiple organs, may occur. Case report: We report the unusual case of a man in his mid ‘70s who presented with septic shock and severe acute respiratory failure requiring intubation. Lack of response to antibiotics, history of intravesical BCG instillation and consistent imaging findings led to further investigations, with bronchoalveolar lavage (BAL) fluid polymerase chain reaction (PCR) results indicating pneumonitis due to Mycobacterium bovis dissemination. Prompt anti-tuberculosis treatment combined with corticosteroids resulted in significant clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection. Conclusions: Due to its non-specific clinical presentation and the relatively low diagnostic yield of conventional microbiological tests, a high index of suspicion is required for prompt diagnosis and treatment of systemic BCG infection. PCR-based assays for mycobacterial DNA identification may represent a valuable tool facilitating timely diagnosis of this uncommon, yet potentially life-threatening infection.
Keywords: BCG instillation; sepsis; pneumonitis; polymerase chain reaction BCG instillation; sepsis; pneumonitis; polymerase chain reaction

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MDPI and ACS Style

Marouli, D.; Pappas, C.; Raissaki, M.; Proklou, A.; Papadakis, E.; Kondili, E. Disseminated Bacillus Calmette-Guérin (BCG) Infection Presenting as Severe Respiratory Failure and Septic Shock. GERMS 2023, 13, 277-281. https://doi.org/10.18683/germs.2023.1395

AMA Style

Marouli D, Pappas C, Raissaki M, Proklou A, Papadakis E, Kondili E. Disseminated Bacillus Calmette-Guérin (BCG) Infection Presenting as Severe Respiratory Failure and Septic Shock. GERMS. 2023; 13(3):277-281. https://doi.org/10.18683/germs.2023.1395

Chicago/Turabian Style

Marouli, Diamantina, Charalampos Pappas, Maria Raissaki, Athanasia Proklou, Eleftherios Papadakis, and Eumorfia Kondili. 2023. "Disseminated Bacillus Calmette-Guérin (BCG) Infection Presenting as Severe Respiratory Failure and Septic Shock" GERMS 13, no. 3: 277-281. https://doi.org/10.18683/germs.2023.1395

APA Style

Marouli, D., Pappas, C., Raissaki, M., Proklou, A., Papadakis, E., & Kondili, E. (2023). Disseminated Bacillus Calmette-Guérin (BCG) Infection Presenting as Severe Respiratory Failure and Septic Shock. GERMS, 13(3), 277-281. https://doi.org/10.18683/germs.2023.1395

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