Two cases of granulomatous hepatitis due to disseminated bacillus Calmette-Guérin (BCG) disease

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  • Eso Yuji
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
  • Mishima Masako
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
  • Arasawa Soichi
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
  • Nakamura Fumiyasu
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
  • Takeda Haruhiko
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
  • Takai Atsushi
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
  • Takahashi Ken
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
  • Ueda Yoshihide
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
  • Marusawa Hiroyuki
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
  • Seno Hiroshi
    Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University

Bibliographic Information

Other Title
  • 播種性bacillus Calmette-Guérin（BCG）症に随伴したgranulomatous hepatitisの2例
  • 症例報告 播種性bacillus Calmette-Guerin(BCG)症に随伴したgranulomatous hepatitisの2例
  • ショウレイ ホウコク ハシュセイ bacillus Calmette-Guerin(BCG)ショウ ニ ズイハン シタ granulomatous hepatitis ノ 2レイ

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Description

<p>Case 1: A 73-year-old man presented with a 7-day history of fever. He underwent transurethral resection of the bladder tumor 8 months previously, followed by 2 rounds of BCG immunotherapy. Laboratory analysis revealed elevated ALT, AST, GGT, and ALP. Liver biopsy revealed multiple epithelioid granulomas in the parenchyma with edema and lymphocytic infiltration in the portal tract, confirming granulomatous hepatitis due to disseminated BCG infection. After 9 weeks' treatment with oral anti-mycobacterial therapy, liver function tests returned to normal ranges and the patient recovered uneventfully.</p><p>Case 2: A 66-year-old man presented with a 3-day history of fever. He had received 4 rounds of BCG immunotherapy for renal pelvic carcinoma. Laboratory data showed increased levels of C-reactive protein, ALT, AST, GGT, and ALP. Liver biopsy revealed multiple epithelioid granulomas in both intralobular and periportal areas, confirming granulomatous hepatitis. After 3 weeks' treatment with anti-mycobacterial therapy, liver function tests results returned to within the normal ranges, and he was discharged on day 37 of hospitalization.</p><p>Conclusion: In cases with a high clinical suspicion of disseminated BCG infection, a liver biopsy should be considered to achieve an early and accurate diagnosis.</p>

Journal

  • Kanzo

    Kanzo 58 (7), 406-414, 2017

    The Japan Society of Hepatology

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