Infiltrated penile papules as a cutaneous manifestation of disseminated BCGitis: A rare dermatologic presentation

Intravesical Bacillus Calmette-Guérin (BCG) therapy is a mainstay for non-muscle invasive bladder cancer, but may rarely cause disseminated infection. We describe a 71-year-old man who developed fever, respiratory failure, and hepatomegaly 1 week after completing maintenance intravesical BCG instillations. Examination revealed multiple erythematous-violaceous papules on the glans penis. Biopsies of both skin and liver showed granulomatous inflammation with focal necrosis; Ziehl-Neelsen, PAS, and Grocott stains, culture, and PCR for Mycobacterium tuberculosis complex were negative. These findings supported a diagnosis of disseminated BCGitis with cutaneous penile involvement. Anti-tuberculous therapy with rifampicin, isoniazid, and ethambutol led to full systemic and cutaneous improvement. Penile involvement in BCGitis is exceedingly uncommon, and microbiologic confirmation is often lacking due to low sensitivity. Awareness of this entity is essential, as early recognition and prompt therapy can prevent severe systemic complications and improve outcomes in patients recently exposed to intravesical BCG.