{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T16:20:58Z","timestamp":1758817258964,"version":"3.40.4"},"reference-count":22,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A 78-year-old man was diagnosed with bladder carcinoma in situ and was successfully treated with intravesical bacillus Calmette-Gu\u00e9rin (BCG) instillations. At 6\u2005months after the last dose, he developed fever, weight loss and malaise. He had an extensive negative workup at an outside hospital and was treated empirically with ciprofloxacin for 2\u2005weeks. The fever resolved but returned months later and he was readmitted with pancytopenia, elevated alkaline phosphatase and ground glass opacities on the chest CT. Bone marrow and liver biopsies showed non-caseating granulomas and were negative for acid-fast bacillus (AFB) and fungal stains.<jats:italic>Mycobacterium tuberculosis<\/jats:italic>complex PCR of the bone marrow was negative. Owing to the high clinical suspicion of disseminated BCG infection, the patient was treated empirically. After 9\u2005weeks of incubation, the bone marrow AFB culture grew<jats:italic>Mycobacterium bovis<\/jats:italic>. Within 2\u2005months of treatment his symptoms resolved and his laboratory results normalised.<\/jats:p>","DOI":"10.1136\/bcr-2013-008949","type":"journal-article","created":{"date-parts":[[2013,4,10]],"date-time":"2013-04-10T04:21:29Z","timestamp":1365567689000},"page":"bcr2013008949","source":"Crossref","is-referenced-by-count":14,"title":["Fever of unknown origin and pancytopenia caused by culture-proven delayed onset disseminated bacillus Calmette-Gu\u00e9rin (BCG) infection after intravesical instillation"],"prefix":"10.1136","volume":"2013","author":[{"given":"Pedro","family":"Dammert","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziad","family":"Boujaoude","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Rafferty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Kass","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,4,9]]},"reference":[{"key":"2025042707134234000_2013.apr09_1.bcr2013008949.1","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/S0022-5347(17)37316-0","article-title":"Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer","volume":"2013","author":"Lamm","year":"1992","journal-title":"J Urol"},{"issue":"Suppl 3","key":"2025042707134234000_2013.apr09_1.bcr2013008949.2","doi-asserted-by":"crossref","first-page":"S86","DOI":"10.1086\/314064","article-title":"Efficacy and safety of bacille Calmette-Gu\u00e9rin immunotherapy in superficial bladder cancer","volume":"2013","author":"Lamm","year":"2000","journal-title":"Clin Infect Dis"},{"key":"2025042707134234000_2013.apr09_1.bcr2013008949.3","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1086\/344908","article-title":"Spectrum of bacille Calmette-Gu\u00e9rin (BCG) infection after intravesical BCG immunotherapy","volume":"2013","author":"Gonzalez","year":"2003","journal-title":"Clin Infect Dis"},{"key":"2025042707134234000_2013.apr09_1.bcr2013008949.4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S0022-5347(17)43892-4","article-title":"Granulomatous hepatitis following intravesical bacillus Calmette-Guerin therapy for bladder carcinoma","volume":"2013","author":"Marans","year":"1987","journal-title":"J Urol"},{"key":"2025042707134234000_2013.apr09_1.bcr2013008949.5","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/S0090-4295(99)00591-9","article-title":"Long-term results of intravesical bacillus Calmette-Gu\u00e9rin therapy for stage T1 superficial bladder cancer","volume":"2013","author":"Brake","year":"2000","journal-title":"Urology"},{"key":"2025042707134234000_2013.apr09_1.bcr2013008949.6","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.urolonc.2007.04.005","article-title":"Effect of advanced age on the development of complications from intravesical bacillus Calmette-Gu\u00e9rin therapy","volume":"2013","author":"Heiner","year":"2008","journal-title":"Urol Oncol"},{"key":"2025042707134234000_2013.apr09_1.bcr2013008949.7","first-page":"831","article-title":"Weekly clinicopathological exercises. 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