Case Report: Acquired Disseminated BCG in the Context of a Delayed Immune Reconstitution After Hematological Malignancy

• Published in: Frontiers in immunology Vol. 12; p. 696268
• Main Authors: Gies, Vincent, Dieudonné, Yannick, Morel, Florence, Sougakoff, Wladimir, Carapito, Raphaël, Martin, Aurélie, Weingertner, Noëlle, Jacquel, Léa, Hubele, Fabrice, Kuhnert, Cornelia, Jung, Sophie, Schramm, Frederic, Boyer, Pierre, Hansmann, Yves, Danion, François, Korganow, Anne-Sophie, Guffroy, Aurélien
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers 03.08.2021; Frontiers Media S.A
• Subjects: Administration, Intravesical; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antitubercular Agents - therapeutic use; BCG; BCG Vaccine - administration & dosage; BCG Vaccine - adverse effects; BCGosis-susceptible PIDs; case report; contamination; Hematologic Neoplasms - drug therapy; hematological malignancies; Host-Pathogen Interactions; Human health and pathology; Humans; Immune Reconstitution; Immunocompromised Host; Immunodeficiency; Immunology; Life Sciences; Male; Middle Aged; Mycobacterium bovis - drug effects; Mycobacterium bovis - immunology; Mycobacterium bovis - pathogenicity; Opportunistic Infections - drug therapy; Opportunistic Infections - immunology; Opportunistic Infections - microbiology; Risk Factors; Treatment Outcome; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - immunology; Tuberculosis, Pulmonary - microbiology; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - immunology; hematological malignancies; case report; BCGosis-susceptible PIDs; BCG; Immunodeficiency; contamination
• ISSN: 1664-3224; 1664-3224
• DOI: 10.3389/fimmu.2021.696268

Disseminated infections due to Bacillus Calmette-Guérin (BCG) are unusual and occur mostly in patients with inborn error of immunity (IEI) or acquired immunodeficiency. However, cases of secondary BCGosis due to intravesical BCG instillation have been described. Herein, we present a case of severe BCGosis occurring in an unusual situation. We report one case of severe disseminated BCG disease occurring after hematological malignancy in a 48-year-old man without BCG instillation and previously vaccinated in infancy with no complication. Laboratory investigations demonstrated that he was not affected by any known or candidate gene of IEI or intrinsic cellular defect involving IFNγ pathway. Whole genome sequencing of the BCG strain showed that it was most closely related to the BCG Tice strain, suggesting an unexpected relationship between the secondary immunodeficiency of the patient and the acquired BCG infection. This case highlights the fact that, in addition to the IEI, physicians, as well as microbiologists and pharmacists should be aware of possible acquired disseminated BCG disease in secondary immunocompromised patients treated in centers that administrate BCG for bladder cancers.