BCG and autoimmunity: Another two-edged sword

BCG immunotherapy for bladder carcinoma has been a long-standing treatment modality that has proved itself efficient and safe. Most of the side-effect s of this treatment are minor and of short duration. There have been, never theless, several reports regarding more severe and long-term complications of BCG therapy-namely inflammatory arthritis, and occasionally systemic aut oimmune manifestations. Here, we present four cases of patients who receive d intravesical instillation with BCG for bladder carcinoma and developed lo ng-standing inflammatory arthritis. One of these patients developed Reiter' s syndrome. We also refer to the possible immune mechanisms by which BCG ca n trigger arthritis, as well as to the link between mycobacterial infection , BCG immunotherapy and autoimmunity. (C) 2001 Academic Press.