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A 54-year-old diabetic male, with idiopathic CD4 + lymphocytopenia, was presented with a two-month history of headache and periocular pain followed by vertigo, left hypoacusia and left
peripheral facial palsy and hypoesthesia. More than a month after admission, a
palate ulcer appeared and Infectious Diseases consultation was required. Mucormycosis
was suspected and the diagnosis was confirmed by histologic examination.
Despite early surgery and combination antifungal therapy, the patient did not survive. This case report illustrates the difficulty in diagnosing a rare
condition with non-specific clinical manifestations and underlines the
importance of a timely multidisciplinary approach in order to recognise this
highly fatal disease earlier. It also
describes a previously non-reported situation of mucormycosis in a patient with
idiopathic CD4 + lymphocytopenia.
Bacillus Calmette-Guérin (BCG) is a live attenuated form of Mycobacterium bovis, initially used in
medicine as a vaccination agent only. The discovery
of its antineoplastic effects in bladder cancer has led to the widespread recognition of BCG intravesical instillation as a
therapeutic option. Although sepsis following BCG intravesical instillation is
rare, it is nonetheless a dreadful and potentially fatal complication. Therapy usually relies on antituberculous therapy and
steroids, alongside with intensive care unit admission. The authors report a case of a 67-year-old male patient who developed septic
shock with multiple organ dysfunction after intravesical BCG instillation and
review the currently available knowledge concerning the risk factors,
diagnosis, management and prevention of BCG sepsis.