Case Report
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Hepatol. Mar 27, 2011; 3(3): 79-82
Published online Mar 27, 2011. doi: 10.4254/wjh.v3.i3.79
Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation
Michail Kaklamanos, Georgia Hardavella, Rodoula Trigidou, Georgios Dionellis, Nikolaos Paissios, Nikolaos Koulouris, Constantin Goritsas
Michail Kaklamanos, Nikolaos Paissios, Constantin Goritsas, Department of Internal Medicine, “Sotiria” Hospital of Chest Diseases, Athens 11527, Greece
Georgia Hardavella, Georgios Dionellis, Nikolaos Koulouris, 1st Department of Respiratory Medicine, University of Athens, “Sotiria” Hospital of Chest Diseases, Athens 11527, Greece
Rodoula Trigidou, Department of Pathology, “Sotiria” Hospital of Chest Diseases, Athens 11527, Greece
Author contributions: Kaklamanos M wrote the paper; Hardavella G, Dionellis G were responsible for treating the patient; Paissios N performed the literature review; Kaklamanos M, Goritsas C performed the liver biopsy and followed-up the patient; Trigidou R established the pathological diagnosis; Goritsas C, Koulouris N supervised this case presentation; and all authors approved the final manuscript for publication.
Correspondence to: Michail Kaklamanos, MD, Department of Internal Medicine, “Sotiria” Hospital of Chest Diseases, 152 Mesogeion Avenue, Athens 11527, Greece.
Telephone: +30-210-7763467 Fax: +30-210-7721658
Received: December 7, 2010
Revised: February 22, 2011
Accepted: March 1, 2011
Published online: March 27, 2011

Bacillus Calmette-Guerin (BCG) intravesical instillation has been adopted in the treatment of patients with superficial bladder cancer. BCG-induced disseminated infection, though rare, has been associated with the histological finding of epithelioid granulomas in different organs, including the liver. We report the case of an adult patient with multi-organ failure, who developed sepsis, acute respiratory failure and acute hepatic failure with encephalopathy whose liver biopsy confirmed the presence of atypical, granulomatous-like lesions. Recovery was observed only after empirical therapy for Mycobacterium bovis with isoniazid, rifampicin, ethambutol and steroids was introduced. This case highlights the importance of a thorough patient assessment in order to exclude other more common causes of hepatic granulomas and to confirm diagnosis. Histological findings may be non-specific when the liver is involved in BCG-induced disseminated infection.

Keywords: Bacillus Calmette-Guerin, Multi-organ failure, Hepatic granulomas, “Bacillus Calmette-Guerin-itis”