BCG and autoimmunity: Another two-edged sword

BCG immunotherapy for bladder carcinoma has been a long-standing treatment modality that has proved itself efficient and safe. Most of the side-effects of this treatment are minor and of short duration. There have been, nevertheless, several reports regarding more severe and long-term complications of BCG therapy - namely inflammatory arthritis, and occasionally systemic autoimmune manifestations. Here, we present four cases of patients who received intravesical instillation with BCG for bladder carcinoma and developed long-standing inflammatory arthritis. One of these patients developed Reiter's syndrome. We also refer to the possible immune mechanisms by which BCG can trigger arthritis, as well as to the link between mycobacterial infection, BCG immunotherapy and autoimmunity.