Page 108 - Livre électronique des Rencontres Franco-Tunisiennes de Pneumologie 2019

P68. MILIARY TUBERCULOSIS COMPLICATING INTRAVESICAL BCG THERAPY

BEN BDIRA B., HAYOUNI M., AISSA S., BENZARTI W., HAYOUNI A., GARROUCH A.,
ABDELGHANI A., GARGOURI I., BENZARTI M.

DEPARTMENT OF PULMONOLOGY, FARHAT HACHED HOSPITAL, SOUSSE, TUNISIA

In April 2018, A 63-year-old patient was admitted due to general fatigue , dyspnea and continuous
pyrexia. He was previously treated for several weeks with intravesical BCG for a bladder
carcinoma. Chest computed tomography scan revealed bilateral miliary nodules. Microbiological
findings including acid fast staining and urine cultures were all negative. Cytological examination
of bronchoalveolar lavage was negative for malignant cells as well as bacteriological examination.
Given the persistent cholestasis, it was decided to perform a liver biopsy. Pathology showed
epitheloid granulomatous inflammation. BCGitis was suspected with pulmonary and hepatic
manifestation.

The patient was treated with Isoniazid, Rifampicin and Ethambutol. His symptoms improved 15
days later and biological tests normalized after 3 months of treatment. Chest CT scan revealed
complete regression of pulmonary nodules after 6 months of therapy.
This case report summarizes possible miliary pulmonary tuberculosis complicating BCG therapy
for bladder carcinoma.

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