Granulomatous Pneumonitis Following Intravesical BCG: What Therapy Is Needed?

A 68-year-old man developed fever, cough, and dyspnea after intravesical bacillus Calmette-Guerin (BCG). Chest radiograph revealed diffuse reticulonodular infiltrates with caseating granulomas on transbronchial biopsy specimen. Cultures were negative and the patient's condition improved with corticosteroids. The mechanism for BCG-induced granulomatous inflammation is poorly understood. Optimal therapy includes corticosteroids.