Uveitis in a patient treated with Bacille-Calmette-Guérin: possible antigenic mimicry of mycobacterial and retinal antigens

Ophthalmology. 2009 Dec;116(12):2457-62.e1-2. doi: 10.1016/j.ophtha.2009.05.021. Epub 2009 Oct 7.


Purpose: To investigate the cellular immune response in uveitis developing after intravesical Bacille-Calmette-Guérin (BCG) applications.

Design: Experimental study.

Participants: A 72-year-old HLA-B27-negative patient with bilateral granulomatous anterior uveitis that developed during the third cycle of intravesical BCG applications she was receiving for treatment of bladder carcinoma.

Methods: The patient's peripheral T cell reactivity to ocular autoantigens was compared with the response to purified protein derivative (PPD) from Mycobacterium tuberculosis. T-cell proliferation and cytokine and chemokine secretion were measured in vitro.

Main outcome measures: Anterior uveitis was treated successfully with topical corticosteroids and cycloplegics.

Results: The following were demonstrated: proliferation to PPD, interphotoreceptor retinoid-binding protein (IRBP), and IRBP-peptide R16, as well as secretion of proinflammatory cytokines in response to PPD, retinal soluble antigen (S-Ag), IRBP, cellular retinal-binding protein (CRALBP), and some S-Ag and IRBP peptides.

Conclusions: These data indicate the generation of a polyclonal autoimmune reaction elicited by BCG. Amino acid sequence alignments revealed homologies between proteins from M. tuberculosis, BCG, and retinal antigens, suggesting antigenic mimicry as a potential cause of uveitis in this patient.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Amino Acid Sequence
  • Antigens, Bacterial / immunology*
  • Autoantigens / immunology*
  • BCG Vaccine / adverse effects*
  • BCG Vaccine / immunology
  • Cytokines / metabolism
  • Female
  • Glucocorticoids / therapeutic use
  • HLA-B27 Antigen / immunology
  • Humans
  • Immunity, Cellular
  • Immunotherapy
  • Lymphocyte Activation / drug effects
  • Molecular Mimicry / immunology*
  • Molecular Sequence Data
  • Mycobacterium / immunology*
  • Mydriatics / therapeutic use
  • Retina / immunology*
  • Sequence Homology, Amino Acid
  • T-Lymphocytes / immunology
  • Urinary Bladder Neoplasms / drug therapy
  • Uveitis, Anterior / drug therapy
  • Uveitis, Anterior / etiology*
  • Uveitis, Anterior / immunology


  • Antigens, Bacterial
  • Autoantigens
  • BCG Vaccine
  • Cytokines
  • Glucocorticoids
  • HLA-B27 Antigen
  • Mydriatics