Int J Infect Dis. 2026 Oct 31:109217. doi: 10.1016/j.ijid.2026.109217. Online ahead of print.
ABSTRACT
Intravesical Bacillus Calmette-Guérin (BCG) is an established treatment for non-muscle-invasive bladder cancer. Although disseminated Mycobacterium bovis BCG infection is a recognized complication of BCG therapy, cardiac implantable electronic device (CIED) involvement is exceptionally rare. We report the second published case of BCG-related CIED infection. A 66-year-old man with an implantable cardioverter-defibrillator (ICD) presented with persistent fever following intravesical BCG therapy. Despite appropriate treatment of concomitant Serratia marcescens bacteremia, fever persisted. Echocardiography was non-diagnostic, whereas 18F-FDG PET/CT suggested device infection. Following complete device and lead extraction, polymerase chain reaction (PCR) of explanted material identified Mycobacterium tuberculosis complex, and cultures subsequently confirmed M. bovis BCG. Concurrent pulmonary involvement was microbiologically confirmed, and the clinical course was further complicated by immune thrombocytopenia. Antimycobacterial therapy resulted in clinical and radiological improvement, and a subcutaneous ICD was successfully implanted after infection control. BCG-related CIED infection should be considered in patients with persistent fever following intravesical BCG therapy, even when echocardiography is non-diagnostic. PET/CT and PCR of explanted device material may facilitate earlier diagnosis and guide management.
PMID:42966446 | DOI:10.1016/j.ijid.2026.109217