Introduction
Bacillus Calmette-Guérin (BCG), a live-attenuated stain ofMycobacterium bovis , has been successfully used as intravesical
immunotherapy in superficial (muscle-sparing) bladder cancer for over 40
years.1 It is the treatment of choice in patients with
urothelial carcinoma in situ (Tis) and early-stage disease
(Ta-T1), and has been shown to reduce both its recurrence and
progression.2 While its precise mechanism of action
remains poorly defined, BCG infection of the urothelium stimulates a
cytokine-mediated immune response and confers anti-tumor activity by
cytotoxic T lymphocytes.3
Local and systemic infectious complications of BCG intravesical therapy
are rare; the most common of these is BCG cystitis, but reported
manifestations include orchitis, sepsis, granulomatous hepatitis,
pneumonitis, osteomyelitis, arthritis, and mycotic aneurysms. In this
report, we describe a rare case of a 71 year old male with bladder
carcinoma in situ treated with two courses of intravesical BCG
who presented with development of a parapharyngeal mass, ultimately
found to be distant mycobacterial infection.