18F-FDG PET/CT follow-up of urothelial bladder carcinoma treated with BCG-therapy: A rare case of BCGitis

We report a diffuse hypermetabolic micronodular lung disease (miliary pattern) in a 61-year-old man who underwent a PET/CT-scan for unexplain asthenia associated with fever symptoms. The patient had a history of urothelial bladder carcinoma treated with transurethral resection and immunotherapy with BCG (Bacille Calmette–Guerin) one year ago. After two month of specific BCG-infection treatment, the post-therapeutic evaluation by 18F-FDG PET/CT show an excellent response of the hypermetabolic pulmonary milary and confirm the diagnosis of BCGitis. This rare case of “BCGitis” after BCG-therapy for an urothelial bladder carcinoma highlights the importance to sensitize nuclear physicians on the etiologies of miliary (BCGite vs. metastases), and on the importance of taking into account the history of the patients thanks to the interrogation.