BCG
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Hepatitis following intravesical administration: case report A 40-year-old man developed hepatitis during intravesical BCG therapy for superficial bladder cancer. The man started receiving intravesical BCG immunotherapy [dosage not stated; duration of therapy not clearly stated] two weeks after a bladder resection. Following the fifth cycle he developed fever, abdominal pain, jaundice and lack of appetite. Examination revealed scleral icterus and pain in the upper-right abdominal area on palpation. He also had an occasional maculopapular rash on his body. Laboratory tests revealed the following values: ALT 110 IU/L, AST 51 IU/L, ALP 68 IU/L, LDH 200 IU/L, GGT 388 IU/L, total bilirubin 3.8 mg/dL, direct bilirubin 3.5 mg/dL, ESR 27 mm/h, haemoglobin 14 g/dL and haematocrit 43%. Ultrasonography and CT scans detected hepatosplenomegaly. After treatment with cefoperazone/sulbactam his liver enzyme levels continued to rise and granulomatous hepatitis in connection with BCG therapy was suspected. Triple anti-tuberculosis treatment was started but the man’s fever continued after 5 days of therapy and the skin eruptions on his face increased. Prednisolone was commenced and after 4 days his fever had decreased. On the fifth day of steroid treatment his clinical and laboratory findings had improved and he was discharged. Prednisolone was eventually discontinued. He continued to receive anti-tuberculosis therapy for 6 months. Akalin S, et al. A case of hepatitis after intravesical BCG immunotherapy. Klimik Dergisi 23: 67-69, Aug 2010. Available from: URL: http://dx.doi.org/10.5152/ kd.2010.20 [Turkish; summarised from an English translation] 803043526 Turkey
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Reactions 13 Nov 2010 No. 1327
