A case of granulomatous hepatitis caused by BCG immunotherapy

Abstract

A case of granulomatous hepatitis caused by BCG immunotherapy for carcinomatous metastasis of unknown origin to cervical lymph node in a 62-year-old female is reported. After BCG injections of 3 times of every 3 months, general malaise, anorexia, fever and jaundice developed gradually. On admission, enlarged right cervical and left axillay lymph nodes were palpable and skin ulcer at the BCG injected region in the left shoulder were seen. Liver function tests revealed, T. Bil. 71mg/dl, GOT 123U, GPT 147U, ALP 16.3U, γGPT 46μU/ml. Biopsy specimen of the enlarged cervical lymph node showed undifferentiated carcinoma of unknown origin. Histology of the skin ulcer showed scattered non-caseating epithelioid granuloma with giant cells in the subcutaneous tissue. Liver biopsy specimen also showed similar epithelioid granulomas in the portal tracts and parenchyma. Although, Myobacterium bovis BCG could be detected in neither liver tissue nor skin ulcer by the routine ZiehlNeelsen stain, diagnosis of granulomatous hepatitis caused by BCG injection was made.