Granulomatous hepatitis as a complication of intravesical Bacillus Calmette-Guerin therapy for bladder carcinoma

Bacillus Calmette-Guerin (BCG) therapy has been proven to be effective treatment for superficial bladder carcinoma with complications that are usually minor and self limited. Although rare, granulomatous hepatitis can develop, and it is important to recognize it and treat it promptly. The hepatitis which occurs appears to be the result of a hypersensitivity reaction to antigens present in the BCG vaccine. Pathological findings include hepatocellular necrosis and pleomorphism, microgranulomas and non-caseous epitheliod granulomas with giant cells. A case of BCG-hepatitis, which developed in a 74-year-old white male following immunotherapy for superficial bladder carcinoma, is described.