Fever
Present due to BCG infection or allergic reaction, flu symptoms, nausea, chills, bladder irritation, headache, fatigue and weakness, muscle pain.
Observe the passage when it is lower than 38°C. Discontinue BCG until symptoms disappear. If the fever is higher than 39℃, or if the fever persists above 38℃ for more than two days, it may be a disseminated tuberculosis infection, and BCG must be discontinued and antipyretics must be given along with anti-tuberculosis treatment. If allergic reaction is suspected, antihistamines should be given.
Seeding BCG infection
Flu-like febrile symptoms lasting for more than 48 hours, body temperature higher than 39℃, and persistent abnormal liver function test values
Discontinue BCG. 3 to 6 months of combined INH, RFP, and EB therapy.
Sepsis
Fever, abnormal liver function tests
Discontinue BCG and administer combined INH, RFP, and EB therapy, with consideration of steroids.
Systemic delayed allergic reaction
With symptoms of anaphylactic reaction such as cough and rash
Discontinue BCG and give antihistamines or steroids immediately. If it is difficult to identify BCG infection, give anti-tuberculosis drugs as well.
Interstitial pneumonia
Fever above 38°C, dyspnea, cough after several days or weeks of BCG bladder perfusion. Abnormal chest x-ray, hypoxemia
Discontinuation of BCG. immediate administration of high-dose steroid therapy (steroidpulsetherapy) If it is difficult to identify whether BCG infection is present, give anti-tuberculosis drugs along with steroids.
Liver dysfunction
Due to BCG infection or allergic reaction
Discontinue BCG. give anti-tuberculosis treatment for 3-6 months. If anti-tuberculosis treatment is ineffective, consider steroid treatment.
Skin rash, urticaria
Occurs due to allergic reactions.
Discontinue BCG. give steroids, anti-tuberculosis drugs as needed in addition to antihistamines.
Symptoms of bladder irritation
Painful urination, dysuria, hematuria, purulence, bladder obstruction (caused by intravesical hematoma)
Give NSAIDS, cholinergic blocking drugs and discontinue BCG until symptoms disappear. INH should be considered when hematuria persists for more than 48 hours.
Prostatitis
Granulomatous prostatitis PSA rise
Observe only the passage when no symptoms appear. When symptoms appear, administer INH and RFP for 3 to 6 months. Discontinue BCG until symptoms disappear. Surgical treatment may be considered.
Renal dysfunction
Pyelonephritis, renal tuberculosis
Discontinue BCG and give anti-tuberculosis treatment
Renal insufficiency
Rising creatinine, rising urea nitrogen
Discontinue BCG. hemodialysis, give steroids, consider giving antituberculosis drugs
Urinary tract obstruction, dysuria, pyelonephritis
Discontinue BCG. administer INH, RFP for 3-6 months
Epididymal BCG infection
Discontinue BCG for painful urination, swelling of epididymis.
3-6 months of INH and RFP treatment.
Ectopic infection
Present due to BCG infection, aneurysm, etc.
Discontinue BCG. administer anti-tuberculosis treatment for 3 to 6 months.
Arthralgia
Discontinue BCG. give NSAIDS. if symptoms persist, consider giving anti-tuberculosis drugs, steroids.
Conjunctivitis
Discontinue BCG. use steroid eye drops.
Reiter’s syndrome
Conjunctivitis, polyosteoarthritis
Discontinue BCG. use steroid eye drops. Polyarthritis with antituberculosis and NSAIDS. consult an orthopedic surgeon.
Bladder atrophy
Painful urination, frequent urination
Discontinue BCG. give steroids or hydro-pressure therapy. Anti-tuberculosis drugs are effective for inflammation or infection, but long lasting symptoms do not require anti-tuberculosis drug treatment.