Hepatic Injury without Granulomatous Formation Associated with Intravesical Bacillus Calmette-Guérin Therapy

• Published in: Internal Medicine Vol. 58; no. 10; pp. 1429 - 1432
• Main Authors: Okano, Hiroshi, Asakawa, Hiroki, Nose, Kenji, Tsuruga, Satomi, Tochio, Tomomasa, Kumazawa, Hiroaki, Isono, Yoshiaki, Tanaka, Hiroki, Matsusaki, Shimpei, Sase, Tomohiro, Saito, Tomonori, Mukai, Katsumi, Nishimura, Akira, Usui, Miki, Baba, Youichirou, Murata, Tetsuya
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15-05-2019; Japan Science and Technology Agency
• Subjects: allergic mechanism; Bacillus; Bacillus Calmette-Guerin vaccine; BCG; Biopsy; bladder carcinoma; Case Report; complication; Eosinophils; Hepatitis; Hypersensitivity; Internal medicine; Leukocytes (eosinophilic); Leukocytes (neutrophilic); liver biopsy; Liver diseases; Prednisolone; steroid; bladder carcinoma; complication; allergic mechanism; liver biopsy; steroid
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.2073-18

A 74-year-old man developed hepatic injury after intravesical Bacillus Calmette-Guérin (BCG) therapy for bladder carcinoma. Although hepatitis-associated disseminated BCG was suspected, granulomatous formations were undetectable. The hepatic injury was considered to have resulted from an allergic reaction to BCG therapy because a histopathological assessment revealed enlarged portal areas with eosinophils and neutrophils. The hepatic injury was resolved by prednisolone. This case suggested that hepatic injury associated with BCG therapy might be due to an allergic mechanism unrelated to disseminated BCG disease. A liver biopsy is needed to confirm the histopathological findings of hepatic injury after BCG therapy in order to differentiate allergic hepatic injury from infectious hepatic injury.