Delayed-onset Disseminated BCG Disease Causing a Multi-System Illness with Fatal Mycotic Aortic Aneurysm

•Disseminated BCG can occur months to years after intravesical BCG infusion and should be considered in such patients presenting with pyrexia of unknown origin.•Obtaining tissue samples for microbiological diagnosis (including for mycobacteria) through PCR and culture is important.•Mycotic aneurysms are a rare but serious complication of disseminated BCG with a high mortality.•Finding effective treatment for BCGosis with mycotic aneurysm is difficult, given intrinsic resistance to pyrazinamide, and concerns over use of fluoroquinolones.•Further published information on the average duration from BCG intra-vesical infusion to presentation of serious complications is needed.