BCG-osis is a variant of systemic infection wherein the lungs, liver, or both are primarily affected (Malkowicz 2002). The clinical picture is similar to that of BCG sepsis; however, patients with BCG-osis are generally he-modynamically stable and present with signs and symptoms indicating pulmonary or hepatic disease. Although an abnormal chest radiograph or elevated liver enzymes suggest the diagnosis, only bronchoalve-olar aspiration or biopsy of the lungs or liver are conclusive (Rischmann et al. 2000). Not uncommonly, these biopsies are negative, indicating that many such cases represent a hypersensitivity reaction rather than a true mycobacterial infection. Regardless, a 6-month course of INH and rifampin is indicated if clinical suspicion is high (refer to Table 13.3) (Lamm et al. 1992). Ethambutol is added if the patient is acutely ill, as are corticosteroids in cases unresponsive to standard treatment. A prior history of BCG sepsis or BCG-osis precludes future treatment with intravesical BCG.
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