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Disseminated Mycobacterium bovis infection post‐kidney transplant following remote intravesical BCG therapy for bladder cancer

Intravesical Bacillus Camlette‐Guérin (BCG) is the treatment of choice for non‐muscle invasive bladder cancer, and has been used successfully for over 40 years. A rare and potentially fatal complication of intravesical BCG therapy is BCG‐induced sepsis. We report a rare case in which a patient with end‐stage renal disease secondary to chronic granulomatous interstitial nephritis underwent remote, pre‐transplant intravesical BCG treatment for high‐grade non‐invasive papillary bladder carcinoma. The patient subsequently received a deceased donor kidney transplant 5 years after BCG therapy, with thymoglobulin induction therapy and standard triple maintenance immunosuppression. Two years post‐transplant, he developed BCG‐induced sepsis confirmed by cultures from urine, blood, and left native kidney biopsy. He died from disseminated BCG‐induced sepsis and failure of his renal allograft. This case highlights the potential adverse reactions associated with intravesical BCG therapy that may occur years after bladder cancer therapy is completed, and should heighten physician awareness for BCG‐related infections during pre‐transplant assessment and post‐transplant care of solid organ transplants recipients.