1
|
Raíces Francisco N, Suárez Gil R, Ayuso García B, Romay Lema E, Rivas Domínguez OM, Rodríguez Ameijeiras E, Besteiro Balado Y, Pérez López A, Rabuñal Rey R. BCGitis with aortoiliac aneurysm involvement: Report of two cases and review of the literature. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:152-157. [PMID: 37487765 DOI: 10.1016/j.eimce.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 07/26/2023]
Abstract
BCGitis is a rare complication after intravesical administration of Bacillus Calmette-Guérin for high-grade superficial bladder cancer and carcinoma in situ. May cause vascular involvement. We present 2 cases and a review of the literature of the case reports pubished on the 10 years prior to April of 2022, when this proyect was finished, which described a case of aortoiliac mycotic aneurysm after receiving this treatment. Of the 51 cases included (49 revised and 2 original), 100% were men, 82% were older than 65 years. The median latency period was 15 months (IQR 18). The most frequent location was the abdominal aorta, rupture occurred in 45,1% of patients. The most frequent symptom was abdominal or lumbar pain (61%), followed by general syndrome (49%). In 39,2% cases, it was associated with retroperitoneal abscesess. Attributable mortality was 13,6%. BCGitis should be included in the differential diagnosis in patients who have received BCG therapy and present vascular involvement, even years after being treated.
Collapse
Affiliation(s)
| | - Roi Suárez Gil
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Blanca Ayuso García
- Unidad de Enfermedades Infecciosas, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Eva Romay Lema
- Unidad de Enfermedades Infecciosas, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | | | - Antía Pérez López
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Ramón Rabuñal Rey
- Unidad de Enfermedades Infecciosas, Hospital Universitario Lucus Augusti, Lugo, Spain; Grupo de Estudio en Infecciones por Micobacterias. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIM-SEIMC)
| |
Collapse
|
2
|
Nishizawa M, Kudo T, Kijima T, Fujii Y. Failed endovascular abdominal aortic aneurysm repair due to Mycobacterium bovis infection following intravesical bacillus Calmette-Guérin therapy. J Vasc Surg Cases Innov Tech 2022; 8:807-812. [PMID: 36507086 PMCID: PMC9729924 DOI: 10.1016/j.jvscit.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
A mycotic aneurysm after intravesical instillation of bacillus Calmette-Guérin (BCG) for early-stage bladder cancer is a rare, but life-threatening, complication. In the present report, we have described the case of a patient who had undergone endovascular aneurysm repair for a rapidly growing saccular abdominal aortic aneurysm after BCG therapy. Three months after endovascular aneurysm repair, the patient had developed an abscess that required open surgery. Cultures from a blood sample and the abscess revealed Mycobacterium bovis BCG. A mycotic aneurysm due to BCG therapy should be suspected in patients with a history of BCG treatment. Such patients should immediately start antitubercular therapy.
Collapse
Affiliation(s)
- Masato Nishizawa
- Department of Vascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Vascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan,Correspondence: Toshifumi Kudo, MD, PhD, Department of Vascular Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan 113-8519
| | - Toshiki Kijima
- Department of Urology, Dokkyo Medical University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
3
|
Palmier M, Monnot A, Tenière T, Cohen Q, Plissonnier D. Mycotic arterial aneurysm secondary to BCG intravesical instillation: A review. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:94-105. [PMID: 35691669 DOI: 10.1016/j.jdmv.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Mycotic aortic aneurysm is a rare and life-threatening pathology. The first case of mycotic aneurysm induced by immunotherapy with bacille Calmette-Guérin for malignancy was published in 1988. The main objective of this review is to characterize this rare pathology. MATERIALS AND METHODS Since then, 60 cases of arterial aneurysm following intra vesical BCG instillation have been described in the literature. All cases have been included, and characteristics have been collected retrospectively, with simple statistical analyses of the cases. RESULTS We present a brief review from 1988 to 2022 enhancing the contemporary understanding of this arterial infection. Mycotic aneurysm secondary to BCG instillation has a poor prognosis, up to 50% complication and 15% mortality at 1 month, whether managed by open repair or endovascular means. CONCLUSION BCG mycotic aneurysm is an extremely serious condition, the diagnosis of which must be considered at an early stage in order to adapt diagnostic and therapeutic strategies.
Collapse
Affiliation(s)
- M Palmier
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France.
| | - A Monnot
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - T Tenière
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - Q Cohen
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - D Plissonnier
- Department of vascular surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France
| |
Collapse
|
4
|
Systematic review of case reports of Bacillus Calmette-Guerin (BCG) vascular infections. Ann Vasc Surg 2022; 83:369-377. [DOI: 10.1016/j.avsg.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 12/24/2022]
|
5
|
Buerger M, Kapahnke S, Omran S, Müller V, Hinterseher I, Greiner A, Frese JP. [Aortic Complications Related to Mycobacterium bovis after Intravesical Bacille Calmette-Guérin Therapy - a Systematic Review]. Zentralbl Chir 2021; 146:506-520. [PMID: 34666364 DOI: 10.1055/a-1592-1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aortic complications after intravesical Bacillus Calmette-Guérin (BCG) application are a rare complication of the treatment of non-muscle invasive bladder cancer. The aim of this systematic review was to perform a descriptive analysis of previously published studies and to discuss the particular challenges of diagnosis and treatment of this rare complication. MATERIAL AND METHODS A literature search was performed in PubMed (1949-2021) and Web of Science (1900-2021) using the search terms "mycobacterium" OR "bovis" OR "BCG" AND "aorta" OR "aneurysm". In a staged review process, publications with the following inclusion criteria were included in data analysis: original paper, full-text availability in English or German and aortic complication after intravesical BCG instillation. We focused on the analysis of BCG-specific medical history data as well as treatment strategies in relation to patient outcome and the occurrence of graft infections during follow-up. RESULTS A total of 60 individual cases were described in 55 published articles. BCG-induced mycotic aortic aneurysms can occur in all segments of the thoracoabdominal aorta, but the infrarenal aortic segment was most commonly affected (65% of cases). The most common configuration was saccular outpouchings (65%). Concomitant infections in other tissues were typical (65%). Patients with mycotic aneurysm presented with or without consecutive aortic rupture in 28% and 63%, respectively. Diagnosis was based on a combination of pathological and microbiological examinations. A common treatment algorithm was surgical infection treatment (85%) and antitubercular therapy (83%). Performed simultaneously, they resulted in a long-term survival of 81%. Graft infection after initial aortic repair with alloplastic material (n = 40) developed in ten patients (25%) during follow-up. DISCUSSION Diagnosis of mycotic aneurysms or vascular complications after intravesical BCG application is exceptionally challenging and a high level of suspicion is required. Diagnosis is based on obtaining sample material of affected regions and the combination of patient's history, clinical presentation and pathological or microbiological examinations. Currently, no consensus guideline for optimal medical treatment options of aortic complications secondary to BCG instillation exists. The combination of surgical treatment and supportive antitubercular therapy seems to achieve the best results. Since the risk of prosthetic infection after the use of alloplastic materials remains high (25%), we strongly suggest evaluating autologous or allogenic aortic replacement during initial aortic repair.
Collapse
Affiliation(s)
- Matthias Buerger
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kapahnke
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Safwan Omran
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Verena Müller
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Irene Hinterseher
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Greiner
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Paul Frese
- Klinik für Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
6
|
Zaza SI, Ghasemzadeh A, Bennett KM. Mycobacterium Bovis Causing Mycotic Aneurysm Secondary to Intravesical Treatment with Bacillus Calmette-Guérin: A Case Report. Ann Vasc Surg 2021; 79:437.e1-437.e6. [PMID: 34644643 DOI: 10.1016/j.avsg.2021.07.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/23/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bacillus Calmette-Guerin (BCG) is a live, attenuated strain of Mycobacterium bovis that is used in the treatment of non-muscle invasive bladder cancer (NMIBC). Vascular complications, including mycotic aneurysms, after BCG therapy are exceedingly rare. In this patient population, the diagnosis of mycotic aneurysms can be delayed or missed due to their non-specific clinical and radiologic presentation. Literature review reveals management of mycotic aneurysms attributable to BCG therapy is widely varied.2,5-8,12,15 CASE REPORT: We report a patient who presented with mycotic aneurysm formation secondary to BCG treatment for bladder cancer that was repaired with in-line reconstruction utilizing cryoartery and buttressed with omental flap. We suggest this as an alternative treatment to in-line prosthetic graft or extra-anatomic reconstruction.
Collapse
Affiliation(s)
- Sarah I Zaza
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Ali Ghasemzadeh
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kyla M Bennett
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
7
|
Buerger M, Kapahnke S, Omran S, Schomaker M, Rief M, Greiner A, Frese JP. Aortic aneurysm and aortic graft infection related to Mycobacterium bovis after intravesical Bacille Calmette-Guérin therapy-a case series. BMC Surg 2021; 21:138. [PMID: 33731071 PMCID: PMC7972206 DOI: 10.1186/s12893-021-01142-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background So called “mycotic” aortic aneurysms account for only 0.7 to 1.3% of all aortic aneurysms and are commonly caused by Staphylococcus aureus and Salmonella species. Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, is part of the therapy of non-muscle-invasive bladder cancer (NMIBC). Case presentation We report a case series of three patients with a mycobacterial graft infection related to BCG after surgical treatment of a presumed mycotic aortic aneurysm as an extremely rare complication after NMIBC treatment. All three patients developed aortic aneurysm after BCG instillation and subsequent mycobacterial graft infection. Conclusion Diagnosis requires a high degree of suspicion because of its nonspecific symptoms and imaging. The pathogen is not detected by standard microbiological testing. Treatment includes triple antimycobacterial therapy and radical surgical interventions. Graft preservation may be considered if no anastomosis is involved. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01142-1.
Collapse
Affiliation(s)
- M Buerger
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - S Kapahnke
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - S Omran
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - M Schomaker
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - M Rief
- Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstraße 10, 10117, Berlin, Germany
| | - A Greiner
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - J P Frese
- Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| |
Collapse
|
8
|
Pham STD, Lee A, Struminger JS, Belkoff KM, Mendoza B, Berman SS. Mycotic infrarenal aortic aneurysm due to mycobacterium after intravesical treatment for bladder cancer. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:354-356. [PMID: 34095641 PMCID: PMC8163880 DOI: 10.1016/j.jvscit.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/21/2021] [Indexed: 11/18/2022]
Abstract
Intravesical instillation of Bacillus Calmette-Guerin, a live-attenuated strain of Mycobacterium bovis, is a common adjuvant therapy for bladder cancer with a low incidence of serious adverse events. The case described herein illustrates a rare complication of intravesical Bacillus Calmette-Guerin instillation that resulted from invasion of the mycobacterium into tissue outside of the bladder lining, also known as microbial dissemination, leading to infection of the aortic wall and development of a mycotic aneurysm, and highlights the therapeutic challenges presented by the aortic pathology in this clinical scenario.
Collapse
Affiliation(s)
| | | | | | | | | | - Scott S. Berman
- Pima Heart and Vascular, Tucson, Ariz
- Correspondence: Scott S. Berman, MD, MHA, FACS, DFSVS, Pima Heart and Vascular, 1815 W. St. Mary's Rd, Tucson, AZ 85745
| |
Collapse
|
9
|
Akabane K, Uchida T, Matsuo S, Hirooka S, Kim C, Uchino H, Shimanuki T. Hybrid operation for infectious thoracic and abdominal aortic aneurysms complicated with Bacillus Calmette-Guérin therapy for bladder cancer: A case report. Medicine (Baltimore) 2021; 100:e24796. [PMID: 33607839 PMCID: PMC7899839 DOI: 10.1097/md.0000000000024796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONAL Bacillus Calmette-Guérin (BCG) intravesical instillation therapy is a widely used treatment for bladder cancer; however, an infectious aneurysm has been reported as a rare complication. PATIENT CONCERNS A 76-year-old man who underwent BCG intravesical instillation therapy for bladder cancer presented with prolonged dull back pain for 3 months. DIAGNOSIS Computed tomography (CT) revealed both thoracic and abdominal aortic aneurysms (AAAs). Follow-up CT at 4 weeks after the initial examination showed rapid enlargement of both aneurysms and typical findings of inflammation. Therefore, he was diagnosed with an impending rupture of infectious aneurysms. INTERVENTIONS Although open surgical resection of both aneurysms and vascular reconstruction were ideal, these operations were considered highly invasive for the patient. Therefore, a hybrid operation consisting of simultaneous endovascular repair of the thoracic aneurysm and open surgery of the abdominal lesion was performed. OUTCOMES BCG "Tokyo-172" strain was identified in the resected sample from the aneurysmal wall, and he continued to receive oral antituberculosis drugs for 6 months. No sign of recurrent infection was observed 1 year after the operation. LESSONS A hybrid operation might be justified as an alternative to the conventional open surgical procedure, especially for patients with infectious aneurysms caused by weak pathogenic bacteria such as, the BCG mycobacteria.
Collapse
MESH Headings
- Administration, Intravesical
- Aged
- Aneurysm, Infected/etiology
- Aneurysm, Infected/microbiology
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/microbiology
- Aortic Aneurysm, Abdominal/surgery
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- BCG Vaccine/administration & dosage
- BCG Vaccine/adverse effects
- Humans
- Male
- Mycobacterium/isolation & purification
- Tomography, X-Ray Computed
- Urinary Bladder Neoplasms/drug therapy
Collapse
Affiliation(s)
- Kentaro Akabane
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Tetsuro Uchida
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Somei Matsuo
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Shuto Hirooka
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Cholus Kim
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Hideaki Uchino
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| | - Takao Shimanuki
- Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata
| |
Collapse
|
10
|
Upchurch GR, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, Murad MH, Perry RJ, Singh MJ, Veeraswamy RK, Wang GJ. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg 2021; 73:55S-83S. [DOI: 10.1016/j.jvs.2020.05.076] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
|
11
|
Effects and Complications of Intravesical Instillation of Bacillus Calmette-Guerin Therapy. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00506-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
12
|
Ikeda S, Shih M, Likourezos A, Flom P, Rhee RY, Youdelman BA. The treatment of tuberculous aortic pseudoaneurysm. J Card Surg 2018; 33:840-852. [DOI: 10.1111/jocs.13952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shinichiro Ikeda
- Department of Surgery, Division of Cardiothoracic Surgery; Maimonides Medical Center; Brooklyn New York
| | - Michael Shih
- Department of Surgery, Division of Vascular Surgery; Maimonides Medical Center; Brooklyn New York
| | - Antonios Likourezos
- Department of Emergency Medicine, Research manager/Statistical Analysis Consultant; Maimonides Medical Center; Brooklyn New York
| | - Peter Flom
- Peter Flom Consulting; New York New York
| | - Robert Y. Rhee
- Department of Surgery, Division of Vascular Surgery; Maimonides Medical Center; Brooklyn New York
| | - Benjamin A. Youdelman
- Department of Surgery, Division of Cardiothoracic Surgery; Maimonides Medical Center; Brooklyn New York
| |
Collapse
|
13
|
Ruptured Iliac Pseudoaneurysm after Intravesical Bacillus Calmette-Guérin: Urgent Endovascular Treatment. Case Report and Literature Review. Ann Vasc Surg 2018; 53:269.e1-269.e9. [DOI: 10.1016/j.avsg.2018.05.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 12/29/2022]
|
14
|
Lareyre F, Reverso-Meinietti J, Carboni J, Gaudart A, Hassen-Khodja R, Raffort J. Mycotic Aortic Aneurysm and Infected Aortic Graft After Intravesical Bacillus Calmette-Guérin Treatment for Bladder Cancer. Vasc Endovascular Surg 2018; 53:86-91. [DOI: 10.1177/1538574418800128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although intravesical therapy with bacillus Calmette-Guérin (BCG) has proven its efficiency in the treatment of early-stage bladder cancer, infectious complications can occur and mycotic aneurysms represent a rare but life-threatening complication. Here, we report the case of an aortic graft infection in a patient with abdominal aortic aneurysm who received BCG instillations for the treatment of bladder cancer. Based on the current knowledge on this rare vascular complication, we discuss factors that may have contributed to its occurrence and review issues to optimize its management and early detection.
Collapse
Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Université Côte d’Azur, CHU, Inserm U1065, Nice, France
| | - Julie Reverso-Meinietti
- Université Côte d’Azur, CHU, Inserm U1065, Nice, France
- Department of Pathology (Laboratoire central d’Anatomopathologie), University Hospital of Nice, Nice, France
| | - Joseph Carboni
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Alice Gaudart
- Department of Bacteriology, University Hospital of Nice, Nice, France
| | - Réda Hassen-Khodja
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Université Côte d’Azur, CHU, Inserm U1065, Nice, France
| | - Juliette Raffort
- Université Côte d’Azur, CHU, Inserm U1065, Nice, France
- Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France
| |
Collapse
|
15
|
Darriet F, Bernioles P, Loukil A, Saidani N, Eldin C, Drancourt M. Fluorescence in situ hybridization microscopic detection of Bacilli Calmette Guérin mycobacteria in aortic lesions: A case report. Medicine (Baltimore) 2018; 97:e11321. [PMID: 30045257 PMCID: PMC6078740 DOI: 10.1097/md.0000000000011321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE To improve the diagnosis of life-threatening Bacilli Calmette Guérin (BCG) arterial aneurysm in patients treated by intravesical instillation of BCG vaccine as adjunctive therapy for non-muscular bladder carcinoma, is a life-threatening condition. Its diagnosis remains cumbersome. PATIENT CONCERNS One patient with a history of intravesical BCG installation presented with aortic aneurysm with routine microscopic examination after Ziehl-Neelsen staining remaining negative. DIAGNOSES We used fluorescence in situ hybridization (FISH) to target the Mycobacterium tuberculosis complex rpob gene in a fresh aortic specimen. FISH yielded fluorescent mycobacteria in aortic lesions; mycobacteria were further confirmed as Mycobacterium bovis BCG mycobacteria by polymerase chain reaction (PCR) sequencing. INTERVENTIONS The patient benefited from an antituberculous treatment combining rifampicin, isoniazid, and ethambunol. OUTCOME A 9-month follow-up indicated a favorable outcome. LESSONS This case report teaches that FISH targeting the M tuberculosis complex rpoB gene should be incorporated in the laboratory investigation of aortic aneurysm in patients with a history of bladder carcinoma.
Collapse
Affiliation(s)
| | - Paola Bernioles
- Infectious Disease Department, Assistance Publique -Hôpitaux de Marseille
| | - Ahmed Loukil
- Aix-Marseille University, Institut de Recherche pour le Développement, Microbes, Evolution, Phylogénie, Infections, Institut Hospitalier Universitaire Méditerranée-Infection, Marseille, France
| | - Nadia Saidani
- Infectious Disease Department, Assistance Publique -Hôpitaux de Marseille
| | - Carole Eldin
- Infectious Disease Department, Assistance Publique -Hôpitaux de Marseille
| | - Michel Drancourt
- Microbiology Laboratory
- Aix-Marseille University, Institut de Recherche pour le Développement, Microbes, Evolution, Phylogénie, Infections, Institut Hospitalier Universitaire Méditerranée-Infection, Marseille, France
| |
Collapse
|
16
|
A mycotic aneurysm of the abdominal aorta caused by Mycobacterium bovis after intravesical instillation with bacillus Calmette-Guérin. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:122-125. [PMID: 29942898 PMCID: PMC6012987 DOI: 10.1016/j.jvscit.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/24/2018] [Indexed: 11/24/2022]
Abstract
Intravesical administration of bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, plays an important role in adjuvant treatment of superficial bladder cancer. Severe adverse events due to this treatment are rare. Complications of varying character and severity have been described, including rare BCG-related vascular infections. In this writing, we present a case of mycotic abdominal aneurysm caused by M. bovis infection related to prior intravesical BCG instillation.
Collapse
|
17
|
Manika K, Efthymiou C, Damianidis G, Zioga E, Papadaki E, Lagoudi K, Kioumis I. Miliary tuberculosis in a patient with tuberculous mycotic aneurysm of the abdominal aorta: Case report and review of the literature. Respir Med Case Rep 2017; 21:30-35. [PMID: 28377878 PMCID: PMC5369367 DOI: 10.1016/j.rmcr.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/13/2017] [Accepted: 03/19/2017] [Indexed: 11/08/2022] Open
Abstract
The combination of miliary tuberculosis and tuberculous mycotic aneurysm has been described in the literature. We present the case of an 84-year-old man who was diagnosed with a mycotic aneurysm of the abdominal aorta and an adjacent soft tissue mass, after a 3- month history of fever. The patient underwent endovascular restoration of the aneurysm and was treated with broad-spectrum antibiotics. One and a half months later the fever relapsed and the chest CT scan revealed findings consistent with miliary tuberculosis and opacities of both upper lobes not present before, while the abdominal CT scan revealed an increase in the size of the para-aortic mass. Tuberculosis was documented by positive culture for M. tuberculosis of bronchial washing and by the CT-guided para-aortic mass biopsy. The patient received anti-TB treatment for 9 months leading to a spectacular improvement of his clinical condition and imaging findings. A review of the literature since 2008 revealed 28 more cases of tuberculous mycotic aneurysm. The treatment and outcome of all cases are described. Mycotic aneurysm of tuberculous etiology remains a reality and has a relatively good prognosis. Although miliary tuberculosis affects mortality even elderly patients may benefit from "aggressive" management and treatment.
Collapse
Affiliation(s)
- Katerina Manika
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Christoforos Efthymiou
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Georgios Damianidis
- 1st Internal Medicine Department, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Elisavet Zioga
- 1st Internal Medicine Department, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Eleni Papadaki
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Kalliopi Lagoudi
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Ioannis Kioumis
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| |
Collapse
|
18
|
Mycotic Aneurysm after Bacillus Calmette-Guérin Treatment: Case Report and Review of the Literature. Case Rep Urol 2017; 2017:4508583. [PMID: 28316859 PMCID: PMC5337836 DOI: 10.1155/2017/4508583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background. Intravesicular Bacillus Calmette-Guérin (BCG) is an effective adjunctive therapy for superficial bladder cancer that has been shown to delay recurrence and progression of disease. Serious side effects are relatively rare but are difficult to diagnosis and commonly overlooked. Case Presentation. We report the case of a patient who was found to have mycotic aortic aneurysms secondary to treatment with BCG after a prolonged course with multiple intervening hospitalizations. Conclusion. Through this report, we discuss our present understanding of BCG infection following treatment and review the literature regarding this particular rare manifestation.
Collapse
|
19
|
Duvnjak P, Laguna M. Left Anterior Descending Coronary Artery and Multiple Peripheral Mycotic Aneurysms Due to Mycobacterium Bovis Following Intravesical Bacillus Calmette-Guerin Therapy: A Case Report. J Radiol Case Rep 2016; 10:12-27. [PMID: 27761190 DOI: 10.3941/jrcr.v10i8.2697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The use of live attenuated intravesicular Bacillus Calmette-Guerin (BCG) therapy is a generally accepted safe and effective method for the treatment of superficial transitional cell carcinoma (TCC) of the bladder. Although rare, < 5% of patient's treated with intravesicular BCG therapy may develop potentially serious complications, including localized infections to the genitourinary tract, mycotic aneurysms and osteomyelitis. We present here a case of a 63-year-old male who developed left coronary and multiple peripheral M. Bovis mycotic aneurysms as a late complication of intravesicular BCG therapy for superficial bladder cancer. The patient initially presented with acute onset pain and swelling in the left knee > 2 years following initial therapy, and initial workup revealed a ruptured saccular aneurysm of the left popliteal artery as well as incidental bilateral common femoral artery aneurysms. Following endovascular treatment and additional workup, the patient was discovered to have additional aneurysms in the right popliteal artery and left anterior descending artery (LAD). Surgical pathology and bacterial cultures obtained from the excised femoral aneurysms and surgical groin wounds were positive for Mycobacterium Bovis, and the patient was initiated on a nine-month antimycobacterial course of isoniazid, rifampin and ethambutol. Including the present case, there has been a total of 32 reported cases of mycotic aneurysms as a complication from intravesicular BCG therapy, which we will review here. The majority of reported cases involve the abdominal aorta; however, this represents the first known reported case of a coronary aneurysm.
Collapse
Affiliation(s)
- Petar Duvnjak
- Department of Radiology, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, USA
| | - Mario Laguna
- Department of Radiology, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, USA; Department of Radiology, VA Zablocki hospital, Milwaukee, USA
| |
Collapse
|
20
|
Lee CJ, Davila D, Dua A, Keyashian B, Dux J, Seabrook GR, Brown K, Malinowski M, Hieb RA, Lewis B. Disseminated Mycotic Aneurysms following Intravesical Bacillus Calmette-Guérin Therapy for Bladder Cancer: Case Discussion and Systematic Treatment Algorithm. Ann Vasc Surg 2016; 39:284.e5-284.e10. [PMID: 27531091 DOI: 10.1016/j.avsg.2016.05.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Numerous case reports have highlighted the relationship between bacillus Calmette-Guérin (BCG) therapy and development of systemic mycotic aneurysms but none have established a management algorithm in patients with suspected vascular dissemination of Mycobacterium bovis. Delay in diagnosis of this disease process will lead to delays in initiation of antimycobacterium treatment to prevent dissemination into other arterial beds and potentially complicate effective surgical treatment leading to aneurysmal rupture and other devastating vascular consequences. Given the increasing number of reported cases in the literature and the ongoing, standard of care utilization of BCG for bladder cancer, we believe that a systematic approach to the management of patients with suspected BCG-related mycotic aneurysms should be set in place to prevent misdiagnosis and delays in treatment. In this report, we discuss the presentation, work-up, and report our treatment algorithm of a patient who developed diffuse peripheral mycotic aneurysms following BCG therapy for bladder cancer.
Collapse
Affiliation(s)
- Cheong J Lee
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Daniel Davila
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Anahita Dua
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Brian Keyashian
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Justin Dux
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Gary R Seabrook
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Kellie Brown
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Michael Malinowski
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Robert A Hieb
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Brian Lewis
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
21
|
Sheron MW, Holt SL, Ingram CW. Mycobacterium bovis Cerebellar Abscess Following Treatment With Bacillus Calmette-Guérin. J Pharm Pract 2016; 30:378-380. [DOI: 10.1177/0897190016636533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bacillus Calmette-Guérin (BCG) is a live, attenuated strain of Mycobacterium bovis that is used to treat superficial bladder cancer. Although its use is typically associated with only mild, localized side effects, rare systemic complications can occur. Disseminated mycobacterium infections after BCG therapy have been reported in over 30 cases; however, central nervous system (CNS) infections do not commonly occur. We report a 74-year-old male who developed a M. bovis cerebellar abscess after receiving intravesical BCG infusion for bladder cancer for less than 1 year. This patient was successfully treated with antituberculosis therapy and corticosteroids. This patient case demonstrates that early-onset M bovis CNS infections can occur after BCG therapy. Patients presenting with altered mental status while on BCG therapy should be evaluated for disseminated infections.
Collapse
Affiliation(s)
- Mollie W. Sheron
- Department of Pharmacy, WakeMed Health & Hospitals, Raleigh, NC, USA
| | - Shannon L. Holt
- Department of Pharmacy, WakeMed Health & Hospitals, Raleigh, NC, USA
- UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Christopher W. Ingram
- Infection Control and Occupational Health, WakeMed Health & Hospitals, Raleigh, NC, USA
| |
Collapse
|