Abstract: TH-PO0718
Bacillus Calmette-Guerin-Induced ANCA-Associated Vasculitis: A Case Report of PR3-Positive Nephritis After Intravesicular BCG
Session Information
- AKI: Prevention, Diagnostics, and Management
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Voors, William, University of Utah Health, Salt Lake City, Utah, United States
- Kakani, Siddhartha, University of Utah Health, Salt Lake City, Utah, United States
- Gilligan, Sarah, University of Utah Health, Salt Lake City, Utah, United States
- Abraham, Josephine, University of Utah Health, Salt Lake City, Utah, United States
Introduction
Bacillus Calmette-Guerin (BCG) is a live, attenuated mycobacterium bovis administered into the bladder leading to a localized immune response to treat bladder cancer. It typically causes fewer side effects compared to systemic chemotherapy however, in rare cases, can lead to severe renal dysfunction. We present a patient with acute renal failure due to interstitial nephritis and focal segmental and glomerulonephritis suspected to be secondary to ANCA associated vasculitis.
Case Description
A 54 year-old man with history of polysubstance use, bladder cancer status post intravesicular BCG, prior endocarditis requiring valve replacement was evaluated in the Renal Clinic for worsening kidney function. Following the treatment with BCG he developed a rash on his lower extremities, prompting hospital admission. During admission he was diagnosed with cutaneous IgA vasculitis based on skin biopsy which was treated with topical triamcinolone and improved. Nephrology was consulted for hematuria and creatinine of 1.7 at discharge. Blood cultures were negative and serologies were positive for ANA (1:80), dsDNA 1:160, low C3, PR3 (36 AU/mL), HCV AB positive and NAAT negative, with positive cryoglobulin and negative HIV. A rapid rise in creatinine to 11.87 mg/dl in 2 weeks was noted and patient was advised to go to the ER but declined with inability to attend his scheduled nephrology follow up. Renal biopsy was finally performed nearly 4 months after the initial presentation when creatinine had improved to 6.53mg/dL and PR3 was negative. Biopsy showed FSGS and concurrent chronic interstitial nephritis with no immune complexes seen, presumed to be sequelae of inflammation related to his vasculitis Patient was started on prednisone 40mg with subsequent improvement in creatinine to 3.3 mg/dL in 4 weeks.
Discussion
Intravesical (bladder) BCG instillation, used to treat non-invasive bladder cancer, acts as an potent immunostimulant. In rare cases, this immune activation can trigger the production of anti-neutrophil cytoplasmic antibodies resulting in autoimmune vasculitis. While BCG is generally considered to be safe, it is important to recognize this rare complication of ANCA vasculitis which can present with renal failure.