Culture-Negative Cystitis With Multiorgan Dysfunction and Septic Shock After Intravesical Bacillus Calmette-Guérin (BCG) Therapy: A Case Report and Review of the Literature

Intravesical Bacillus Calmette-Guérin (BCG) therapy is a live attenuated strain of Mycobacterium bovis (M.bovis), used in the treatment of non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT) as adjuvant therapy.Complications of intravesical BCG therapy range from chemical cystitis to disseminated BCG infection.We present a case of an 85-year-old man undergoing intravesical BCG therapy post-TURBT for NMIBC who was initially admitted for complicated chemical cystitis with progression to multiorgan failure and death over a four-week hospitalization.Treatment for systemic BCG infection with antimycobacterial agents and corticosteroids was not initiated until day 12 of hospitalization due to a clinical picture muddled by the patient's comorbidities, the rarity of disseminated BCG, and waxing and waning clinical responses to therapies over the course of the patient's hospitalization.Early recognition and timely treatment are necessary to prevent serious complications or death, as systemic BCG infection can both progress rapidly and respond slowly to treatment.However, the diagnosis of BCG infection/inflammatory response can be difficult as it is often a diagnosis of exclusion and presents with nonspecific diagnostic findings.This case highlights that to optimize patient outcomes, clinicians need a high index of suspicion and should consider early treatment for systemic BCG reaction in patients with multiorgan dysfunction and a history of intravesical BCG treatment, especially in those with negative microbiological data.