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The Pieces of the Puzzle—Disseminated BCG Infection With Mycotic Abdominal Aneurysm Identified on a Blood Culture

Denkinger, Claudia M. MD*; Aroesty, Julian M. MD*; Weinberg, Arnold N. MD; Karchmer, Adolf W. MD*

Infectious Diseases in Clinical Practice: January 2013 - Volume 21 - Issue 1 - p 17–20
doi: 10.1097/IPC.0b013e31826babf6
Review Articles

Abstract: Intravesicular bacillus Calmette-Guérin (BCG) instillation is a widely used immunotherapy for superficial bladder cancer. Although this treatment is generally well tolerated with primarily local adverse effects, systemic adverse effects, including fever, pneumonitis, and hepatitis, have been reported. A disseminated infection with the development of mycotic aneurysms is very rare and results in significant morbidity and mortality.

We report an immunocompetent patient with disseminated BCG infection and mycotic aneurysms diagnosed based on imaging and a positive mycolytic blood culture and subsequently confirmed by histopathology. We review the literature of other cases of disseminated BCG infection with mycotic aneurysms and summarize the classic presentation, the treatment, and outcomes.

From the *Department of Medicine, Beth Israel Deaconess Medical Center;and †Department of Medicine, Massachusetts General Hospital, Boston, MA.

Correspondence to: Claudia M. Denkinger, MD, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Lowry Medical Office Bldg, 110 Francis St, Suite GB, Boston, MA 02215. E-mail: cdenking@bidmc.harvard.edu.

The authors have no funding or conflicts of interest to disclose.

© 2013 Lippincott Williams & Wilkins, Inc.