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.