BCG installation in bladder for stage 1 bladder carcinoma is becoming more common with increasingly aging population. BCG can be absorbed systemically and cause granuloma formation in almost any organ of the body with symptom onset from a few hours after installation of BCG to several years later. The treatment can vary from close observation in some cases, to use of isoniazid and rifampin with and without steroids for 3-9 months. The overall prognosis is very good. There is need for greater awareness among physicians for considering BCG related disease processes in patients with past history of BCG installation so appropriate cultures can be send and treatment instituted.