GENERALIZED BCGITIS AFTER INTRAVESICAL IN STILLATION OF CALMETTE-GUERIN BACILLUS

BCG has been disappointing as immunotherapy of numerous cancers, but i t has been clinically successful in the intravesical treatment of blad der carcinomas sparing the muscle coat; it has indeed become the refer ence treatment for this type of cancer. However, complications are rep eatedly reported, including generalized BCGitis. We report such a case with positive BCG culture. From the cases already published there eme rges a homogeneous and often subacute clinical presentation suggestive of an ordinary pathogen. Bacteriology is not very helpful, even when recent techniques are used, and therefore the diagnosis rests on the c ontext and, when samples are taken, on suggestive histological finding s. To discuss the physiopathology of BCGitis - generalized immune reac tion or multifocal BCG proliferation - is not useless since treatment depends on it. It is probable that these 2 mechanisms working together can be incriminated, justifying the prescription of both antibiotics and corticosteroids. When this is done, the prognosis seems to be favo urable in most patients. Yet a strict respect of contra-indications an d a very careful subsequent radiotherapy should reduce the risks.