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This case report describes a 69-year-old man developing fever, headache, and impaired consciousness three days after his final BCG instillation. Initial viral encephalitis treatment with acyclovir failed, prompting suspected autoimmune encephalitis. Steroid therapy, with adjunct plasmapheresis, led to marked clinical improvement and long-term stability without relapse.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-first-case-of-bacillus-calmette-guerin-induced-autoimmune-encephalitis-case-report/433342/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-first-case-of-bacillus-calmette-guerin-induced-autoimmune-encephalitis-case-report/433342.png","ImageObject",300,407,{"name":92,"@type":93},"hdkawk","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why was autoimmune encephalitis suspected instead of viral encephalitis?","Question",{"text":113,"@type":114},"The patient showed no clinical improvement after acyclovir, and subsequent reassessment favored an exacerbation of autoimmune encephalitis over persistent viral disease despite negative viral cultures and herpes PCR.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What treatments were used and what was the outcome?",{"text":118,"@type":114},"Steroid therapy was initiated, followed by steroid pulse therapy; plasmapheresis was added. The patient’s symptoms improved markedly to the level seen before BCG treatment and he remained stable and relapse-free.",{"name":120,"@type":111,"acceptedAnswer":121},"How soon after intravesical BCG treatment did neurological symptoms occur?",{"text":122,"@type":114},"Neurological symptoms began three days after the final (fourth) intravesical BCG treatment.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},433342,1790818320,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52,"preview_page_count":4},3985747859855,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","IJU Case Reports  \n CASE REPORT  OPEN ACCESS   \nThe First Case of Bacillus Calmette-Guérin-Induced Autoimmune Encephalitis  \nMakoto Ishii  | Haruto Honda | Seigo Machiya | Hiromu Horitani | Sayaka Horii | Masao Kobayashi | Yutaka Ono Department of Urology, Higashiosaka City Medical Center, Higashiosaka City, Osaka, Japan  \nCorrespondence: Makoto Ishii ([ishii.urol@gmail.com](ishii.urol@gmail.com))  \nReceived: 11 September 2025 | Revised: 3 December 2025 | Accepted: 16 December 2025  \nKeywords: autoimmune encephalitis | BCG-related side effect | intravesical BCG therapy | plasmapheresis | steroid pulse  \nABSTRACT  \nIntroduction: Intravesical bacillus Calmette-Guerin (BCG) therapy is a standard treatment for intermediate to high-risk nonmuscle invasive bladder cancer. While local side effects are common, systemic complications are rare and can be serious.  \nCase Presentation: A 69-year-old man presented with episodes of fever, headache, and impaired consciousness. He had undergone intravesical BCG therapy 3 days before presentation. He was initially diagnosed with viral encephalitis and treated with acyclovir, but showed no clinical improvement. Given the lack of response, autoimmune encephalitis was suspected, and steroid therapy was initiated, resulting in marked clinical improvement. Plasmapheresis was performed in addition to steroid therapy, and his condition improved to the level observed prior to BCG treatment. To date, he remains stable and relapse-free.  \nConclusion: To our knowledge, this is the first reported case of BCG-induced autoimmune encephalitis after intravesical therapy.  \n1 | Introduction  \nWe present an unrecognized neurological complication of bacillus Calmette-Guerin (BCG) therapy for non-muscle invasive bladder cancer [1] . Intravesical instillation of live BCG is recommended for intermediate to high-risk non-muscle invasive bladder cancer, but some patients suffer toxicity and serious adverse events. We report autoimmune encephalitis, a rare adverse event related to BCG intravesical instillation therapy.  \n2 | Case Presentation  \nA 69-year-old man presented at the emergency department with episodes of fever, headache, and impaired consciousness. He was treated with transurethral bladder tumor resection for intravesical tumor recurrence after surgery for right ureteral cancer. He was then treated with BCG intravesical instillation because the pathology result was carcinoma in situ. Three days after his fourth and last BCG treatment, the patient developed reactive  \narthritis, and steroid treatment (prednisolone 20 mg daily) was started. One month after the start of steroid treatment, he presented with the aforementioned complaints.  \nThe patient's level of consciousness was GCS E4V3M6, with mild memory impairment and disorientation. He had no rigidity of the neck. At the time of presentation, vital signs were stable with the exception of fever. Blood work revealed a normal white blood cell count (7400/μL), slightly low hemoglobin (9.2 g/ dL), normal platelets (222 × 103/μL), slightly high creatinine (1.24 mg/dL), slightly high C-reactive protein (1.41 mg/dL), and normal serum sodium, potassium, calcium, and coagulation parameters. Cerebrospinal fluid (CSF) analysis showed an elevated cell count of 15.33/μL (normal range 0–5 μL), with a mononuclear cell predominance (93%), a normal glucose level of 70 mg/ dL (normal range 40–75 mg/dL), and a slightly high protein level of 53 mg/dL (normal range 10–40 mg/dL) . Head computed tomography (Figure 1) and magnetic resonance imaging (MRI)(Figure 2) were unchanged. Electroencephalography showed no abnormalities.  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2025 The Author(s). IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association.  \nIJU Case Reports, 2","cbCaicBqOuxzPIEf","https://ap.wps.com/l/cbCaicBqOuxzPIEf","pdf",324879,"English","# Abstract\n# Introduction\n# Case Presentation\n## Clinical course and treatment\n## Diagnostic workup\n# Conclusion\n# Keynote Message","[{\"question\":\"Why was autoimmune encephalitis suspected instead of viral encephalitis?\",\"answer\":\"The patient showed no clinical improvement after acyclovir, and subsequent reassessment favored an exacerbation of autoimmune encephalitis over persistent viral disease despite negative viral cultures and herpes PCR.\"},{\"question\":\"What treatments were used and what was the outcome?\",\"answer\":\"Steroid therapy was initiated, followed by steroid pulse therapy; plasmapheresis was added. The patient’s symptoms improved markedly to the level seen before BCG treatment and he remained stable and relapse-free.\"},{\"question\":\"How soon after intravesical BCG treatment did neurological symptoms occur?\",\"answer\":\"Neurological symptoms began three days after the final (fourth) intravesical BCG treatment.\"}]","The First Case of Bacillus Calmette-Guérin-Induced Autoimmune Encephalitis - Case Report | PDF",1790663684]