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A 79-year-old man was admitted to hospital with fever, rigours and malaise 1 week after completing his seventh intravesicular BCG immunotherapy treatment for carcinoma in situ of the bladder. On admission, respiratory examination was normal with a peripheral oxygen saturation of 94% on air and a normal white cell count but raised C reactive protein of 111. His chest radiograph was normal (figure 1). He was treated for presumed urinary sepsis with intravenous antibiotics while awaiting results of microscopy and culture of urine and blood cultures.
By day 5, the patient had become progressively breathless requiring high flow oxygen to maintain his oxygen saturations. Urine and blood cultures taken …
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