A rare case of multi-focal human TB after BCG instillation for non-muscle-invasive bladder cancer.

Objective: To describe a left epididymitis and para-aortical involvement caused by reactivation after bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer.

Patient And Methods: A Caucasian male, aged 76 years, exposed to bacillus Calmette-Guérin for a high-grade non-muscle-invasive bladder cancer in 2015, reported painful and progressive left scrotal swelling with purulent discharge from a cutaneous fistulous track that yielded, on liquid culture, a pan-susceptible strain. Moreover, after 6 months of anti-tuberculosis treatment, an abdominal peri-aortic mass, sized 4 cm, was found and a surgical biopsy showed necrotizing granulomas; however, although smear microscopy and Xpert MTB/Rif™ performed on fresh biopsy sample were positive, liquid cultures resulted negative, indicating treatment efficacy.

Results: Numerous peculiar and multi-organ involvement due to BCGitis after intravesical immunotherapy have been previously described, including 17 scientific articles about epididymitis, however, no reports so far showed reactivation of after bacillus Calmette-Guérin treatment.

Conclusion: Although BCGitis is more prevalent in patients undergoing bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer, tuberculosis by other species of should be always ruled out by molecular and conventional microbiology in patients with a history of exposure.