Mycobacterial sepsis following instillation of intravesical Calmette-Guerin bacillus. Is corticosteroidal therapy necessary?

Clinical case - We report two cases of mycobacterial sepsis after intravesi cal BCG immunotherapy in superficial bladder tumors. In both cases, patient s had experienced a traumatic catheterization, Case n(o) 1: A 64 year old m an was admitted to hospital with septic shock, following the second BCG ino culation. During 3 weeks, he received a course of ciprofloxacine, but his c ondition did not improve. A liver biopsy showed granuloma with multinucleat ed giant cells. The patient received anti-tuberculous drugs and corticoster oids after a liver biopsy. His condition improved, fever disappeared, and l iver enzymes slowly returned to normal values. Case n(o) 2: A 70 year old m an had similar presentation following the third inoculation: sepsis and mul ti-organ failure. A blood culture proved positive with M. bovis. He was tre ated withanti-tuberculous drugs and corticosteroids and his conditions rapi dly improved. Comments - Our study results favor the use of corticosteroids in associatio n with anti-tuberculous agents. (C) 2001 Editions scientifiques et medicale s Elsevier SAS.