<i>Mycobacterium bovis</i> Granulomatous Pachymeningitis after Intravesical BCG Immunotherapy

Intravesical adjuvant administration of attenuated live strain of Mycobacterium bovis or the bacillus Calmette-Guerin (BCG) is the choice of care for high-grade non-muscle invasive bladder cancer after resection. 1 BCG vaccine is also used to prevent Mycobacterium tuberculosis (TB) in many countries. Although mostly safe, intravesical injected BCG may stay in the urinary tract for more than a year and cause local or disseminated infection, especially in immunocompromised patients. Urinary tract-psoas abscess, pulmonary TB, mycotic aortic aneurysm, bone-joint infections, and even Guillain-Barre syndrome are some of the reported conditions. 2 We present a rare and possibly the first reported case of M. bovis intradural, extramedullary granulomas following BCG immunotherapy.