BRIEF REPORT - MENINGITIS DUE TO LATROGENIC BCG INFECTION IN 2 IMMUNOCOMPROMISED CHILDREN

VACCINATION with bacille Calmette-Guerin (BCG), an attenuated strain of Mycobacterium bovis, has been used extensively throughout the world as immunoprophylaxis against tuberculosis. Since 1976, intravesical administration of BCG has been used to treat superficial transitional-cell carcinoma of the bladder.(1) In both uses the complications of therapy have been rare, and the majority of serious side effects have occurred in immunocompromised persons.(2-5) In this report we describe two children with leukemia treated at our institution in whom BCG-associated meningitis developed. Neither child was receiving BCG as part of the immunotherapy for leukemia, and neither had a history of BCG vaccination. We speculate that both infections may have been caused by the accidental inoculation of BCG during the administration of intrathecal chemotherapy. Although proof is lacking, we believe that the contamination occurred in or near the biologic-safety cabinet in the hospital pharmacy, where both the chemotherapeutic agents used to treat these patients and the BCG used to treat patients with bladder cancer were prepared.