A Case of Granulomatous Hepatitis Developed after Intravesical BCG Instillation for Bladder Cancer

Granulomatous hepatitis is a rare but serious systemic complication of intravesical Bacillus Calmette-Guerin (BCG) therapy, which has been proved more effective than most chemotherapeutic agents in the treatment of superficial bladder tumors and carcinoma in situ. Recently, we experienced a 64 year-old male with granulomatous hepatitis which had occurred following an intravesical BCG immunotherapy for an adjuvant treatment of superficial bladder cancer. The patient took isoniazid (300 mg) due to fever that had developed soon after an intravesical BCG immunotherapy. When he presented with clinical features of hepatic failure and sepsis, it was difficult to differentiate granulomatous hepatitis from isoniazid-induced hepatotoxicity. The patient died 20 days after the intravesical BCG immunotherapy (2 days after liver biopsy). This case indicates that granulomatous hepatitis is a fatal complication of the intravesical BCG therapy. Thus, a close follow-up and prompt diagnostic effort with optimal treatment should be instituted.