A 68-year-old man developed fever, cough, and dyspnea after intravesic
al bacillus Calmette-Guerin (BCG). Chest radiograph revealed diffuse r
eticulonodular infiltrates with caseating granulomas on transbronchial
biopsy specimen. Cultures were negative and the patient's condition i
mproved with corticosteroids. The mechanism for BCG-induced granulomat
ous inflammation is poorly understood. Optimal therapy includes cortic
osteroids.