A 72-year-old male with a history of hypertension, chronic obstructive pulmonary disease, ex-smoker and diagnosed with papillary urothelial bladder carcinoma (T1G2).
Transurethral resection of the tumor was performed and 3 weeks later treatment was initiated with a long cycle of endovesical instillations of BCG (Connaught strain, 109 colony-forming units per dose) administered weekly.
After receiving 3 sessions he came to the emergency department due to general malaise and fever (38.5o) of ten days of evolution.
No other symptoms were observed.
Physical examination revealed anodyne with normal pulmonary auscultation, negative bilateral renal percussion, and non-painful or congestive prostate, size II/IV and adenomatous consistency.
Blood count showed mild leukocytosis without neutrophilia (leucocytes 12100 and 63.7% neutrophils).
Urocultivations and blood cultures were sterile and the search for acid-alcohol resistant bacilli in urine was unsuccessful.
The chest X-ray showed bilateral and diffuse involvement of small millimetric nodules with calcified thick lymph nodes, compatible with miliary TBC.
Computed tomography (CT) showed gross adenopathies calcified in right hilium and pulmonary ligament and bilateral and diffuse parenchymal involvement of small millimetric nodules affecting all lung fields.
The patient was admitted to hospital and was treated with isoniazid, rifampicin and etambucil.
The patient improved his general condition so he was discharged and followed up on an outpatient basis.
During follow-up there were no adverse effects of the medication or new febrile episodes or other symptoms.
Antituberculosis therapy was initiated for 6 months following BCG instillations.
The control CT scan at two months showed a decrease in the size of the lymph nodes and a decrease in the number of nodules, with complete disappearance in some lung segments.
