Urogenital infection with M. bovis BCG most probably as a result of BCG instillation 21 years ago.

We present the case of a man in his late 70s who developed urogenital infection with M. bovis BCG most probably following BCG instillation for bladder cancer, a surprising 21 years after the BCG treatment had ended.The patient presented with an indolent testicular swelling initially presumed to be testicular cancer. After surgical exploration, the swelling proved to be a M. bovis BCG-infected granuloma. Treatment consists of ethambutol, rifampicin and isoniazid over several months, which can cause severe side effects.We conclude that any unclear lesion or tumour in a patient who has had BCG instillation should be tested for mycobacteria along standard histological and microbiological analyses.