{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T23:42:36Z","timestamp":1792539756157,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T00:00:00Z","timestamp":1766620800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Intravesical Bacillus Calmette\u2013Gu\u00e9rin (iBCG) immunotherapy is the standard adjuvant treatment of non-muscle-invasive bladder cancer (NMIBC). Among the potential complications, cases of mycotic aneurysms and acute respiratory distress syndrome (ARDS) are rare but can be life-threatening. Because prior reports have not included whole-genome sequencing (WGS) of clinical Mycobacterium bovis BCG (M. bovis BCG) isolates to assess whether the infecting strain acquires mutations in vivo, we performed WGS in a severe disseminated iBCG-related infection. A 72-year-old man with bladder cancer underwent iBCG instillation. Twelve months after the final instillation, the patient developed an abdominal aortic aneurysm, which was detected and treated with endovascular aneurysm repair (EVAR). Two months later, the patient presented with fever, abdominal pain, and septic shock. Contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography\/CT (FDG-PET\/CT) showed rapid aneurysm enlargement. Ziehl\u2013Neelsen staining and PCR of aortic material identified M. bovis BCG. Direct PCR on BAL fluid and urine was negative; however, BAL and urine culture subsequently grew M. bovis BCG, and PCR performed on the culture isolate confirmed M. bovis BCG. Despite combined antituberculosis triplet therapy (isoniazid, rifampicin, and ethambutol), the patient developed ARDS, which gradually improved after surgical management. WGS (with &gt;96% genome coverage) showed the isolate was highly concordant with the vaccine strain and lacked additional virulence-associated mutations, including in esxM. This case illustrates that severe systemic iBCG-related complications can occur without detectable in vivo acquisition of virulence-enhancing mutations; however, interpretation is limited by the single-case design and the absence of host genetic susceptibility testing. Our findings underscore the need for prolonged vigilance regarding late-onset vascular and pulmonary complications after iBCG, and highlight the importance of early multidisciplinary management.<\/jats:p>","DOI":"10.3390\/ijms27010238","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:50:21Z","timestamp":1766710221000},"page":"238","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Whole Genome Sequencing of Clinical Mycobacterium bovis BCG in Disseminated Infection with Mycotic Aneurysm and ARDS After Intravesical Therapy: A Case Report"],"prefix":"10.3390","volume":"27","author":[{"given":"Yuta","family":"Nakagawa","sequence":"first","affiliation":[{"name":"Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3919-8830","authenticated-orcid":false,"given":"Chie","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"},{"name":"Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidetake","family":"Kawajiri","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Paediatric Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0734-4047","authenticated-orcid":false,"given":"Makoto","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomomi","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiji","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Kambayashi","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, Fukuchiyama City Hospital, Fukuchiyama 620-0056, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keitaro","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Hamashima","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2123-6122","authenticated-orcid":false,"given":"Tetsuhiro","family":"Yamano","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1595-8524","authenticated-orcid":false,"given":"Tohru","family":"Inaba","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiko","family":"Kooguchi","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichiro","family":"Oda","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Paediatric Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2288-077X","authenticated-orcid":false,"given":"Satoshi","family":"Mitarai","sequence":"additional","affiliation":[{"name":"Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo 204-8533, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6123-5212","authenticated-orcid":false,"given":"Yoko","family":"Nukui","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2018). 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[Amended 2022 Mar 10; Partially Amended 2023 Mar 27], Available online: https:\/\/www.mext.go.jp\/content\/20250325-mxt_life-000035486-01.pdf."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/1\/238\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T05:15:52Z","timestamp":1766812552000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/1\/238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,25]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["ijms27010238"],"URL":"https:\/\/doi.org\/10.3390\/ijms27010238","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,25]]}}}