Systemic BCG with
Pneumonitis
By Carrie Fitzgerald
Uro 1
Urology consult for patient with
irritative symptoms R/O UTI
81 year old African American male,
appears younger then stated
age
• Presents with c/o irritative
voiding sxs for 24 hr. daughter
noticed diaphoresis acute
change MS; dysuria, fever 103
brought pt to ER.
• Pt seen by medicine and started
on empiric parenteral antibiotic
treatment after urine culture
obtained
• Found out 72 hours later patient
was post BCG intravesical
treatment, including dysuria and
frequency and urology consult
obtained
Hospital day 3
PMHx
Superficial Bladder Ca sp BCG 6
week induction; maintenance
dose 72 hr prior; ho sxs post
intraves
CaP s/p RRP
Dementia
HTN
Meds : Aricept, Cozaar , Enablex,
HCTZ, Norvasc, Colace
Soc Hx: Tob 30 pack yr, no ETOH,
no illicits
Fam Hx: no GU malignancies
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VS 100.2 82 22
154/86 96%
AAOx2, NAD
CTAB, S1S2 no
murmurs
Soft, NT no sp ttp, no
CVA tenderness
Uncircumsize. Nl
Descended. Foley
gravity, urine clear,
yellow, no meatal
erosion bld. Prostate
absent.
Labs and Exam
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WBC 5.4 (13.5/ band
% 13 on admit)
H/H 11.4/32
12.9/36.4 on admit
BUN 13 Cr 1.16
(35/2.47 on
admission)
AST 93 ALT 94 AlkP
92
T bili 2.26 D bili 1.18
Sterile pyruria (W 2050)
CXR
Assessment:
UTI vs BCG side
effect vs systemic
BCG
Hyperpyrexia
AKI
Hyperbilirubinemia
Anemia
HTN
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Bld/U Tb cx
ID consult
Levaquin, INH
WBC Scan
Abd US
CT scan abd/pel
Renal cyst /abscess
drainage
Assessment and Plan
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Bld Cx : no growth
5d
Ucx : no growth 24
hrs
Misc Cx : R renal
cyst aspirate neg
for AFB, aerobes,
anaerobe
Results and PE
Episodes of fever
(Tmax 104.4) and
diaphoresis Q8-12
hour
Expiratory wheezes;
O2 sat80%
Rigors
Change in MS
Assessment
Disseminated BCG
+/- hypersensitivity
rxtn
Respiratory distress
Hepatitis BCG vs
Pharm
Hyperpyrexia
Anemia – AOCD
w/folate def
Urinary incontinence
AKI
HTN
Hospital Day 13
WBC 9.6
(11/band% 25 hosp
day 17)
H/H 8.3/24
(7.5/21.9 hosp 17)
BUN 21 Cr 1.38
AST 162 ALT 78
AlkP 102
T bili 3.01 D bili 1.93
PSA < 0.01
HepB ab/Ag - neg
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Rifampin 600 mg po
Qd
Pyrazinamide 1000
mg po Qd
Isoniazid 300 mg po
Qd
Levaquin 250 mg po
Qd
Stopped
Pyrazinamide on
10/27 started
Ethambutol 1600mg
po daily
Treatment
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Zosyn 3.375 g x1
Vancomycin 750 mg
x1
Rocephin 1g x1
Azithromycin 500 mg
x1
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Lamm consult
Started Solumedrol
40 mg IVP Q 6
hours hosp day 17
with slow taper
Discharged to rehab
hosp day 20
In Addition