Disseminated Infection After Bacille Calmette‐Guérin Instillation for Treatment of Bladder Carcinoma

staining of blood and sputum smears was negative. Acid-fast bacilli were identified in urine, and culture of urine yielded M. bovis‐BCG. A chest roentgenogram was clear. Epithelioid cell granulomas with polynucleated giant cells, without caseous necrosis, were seen in a bone marrow biopsy specimen, and culture of the bone marrow aspirate yielded M. bovis‐BCG. Isoniazid, rifampin, and ethambutol treatment was prescribed, and there was a good clinical response. Hematologic abnormalities returned to normal over the 3 weeks following the beginning of treatment. Two months later, his clinical status worsened, and a CT scan of the abdomen detected the presence of a large solid-appearing mass in the left kidney and a thrombus of the left renal vein that extended into the inferior vena cava. A diagnosis of renal cell carcinoma was suspected. The patient’s subsequent course was characterized by progressive anasarca, and he died 7 weeks later. BCG is a live strain of M. bovis that, although attenuated, may exhibit some invasive properties. The developmental course of the systemic reaction and the correlation of its intensity with the BCG