Tuberculous Peritonitis as a Complication of Intravesical Bacille Calmette-Guérin Instillation for Superficial Bladder Cancer: Report of a Case

A 72-year-old man was treated with intravesical instillation of Bacille Calmette-Guerin for superficial bladder cancer. After six sessions of induction BCG therapy and three weekly maintenance treatments 3 months later, he developed abdominal pain and fullness, and low grade fever. Under laparoscopy, biopsy of the peritoneum revealed caseating granulomatous inflammation. Cultures for mycobacterium tuberculosis complex (MTBC) and direct detection of MTBC DNA from the peritoneal fluid were positive. Our patient appeared to have developed tuberculous peritonitis after intravesical BCG therapy. Antituberculous therapy with isoniazid, rifampicin, and ethambutal was given daily and the patient’s symptoms resolved. To our knowledge, such a complication has only been reported previously in a uremic patient, requiring dialysis.