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Geetha SD, Chavarria HD, Abdelwahed M, Kataria N, Bijol V, Das K. Granulomatous myocarditis arising from intravesical Bacillus Calmette-Guérin therapy leading to death diagnosed by postmortem examination: a case report. J Med Case Rep 2024; 18:12. [PMID: 38195538 PMCID: PMC10777644 DOI: 10.1186/s13256-023-04310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Intravesical Bacillus Calmette-Guérin (BCG) is used as a standard adjuvant therapy for non-muscle invasive urothelial cancer. Most patients tolerate the treatment well, with mild side effects. Systemic complications are extremely rare, occur due to BCG dissemination and are associated with immunocompromised state and urothelial breach. CASE PRESENTATION We present a case of a 78-year-old male, a former smoker, with history of non-muscle invasive urothelial carcinoma status post partial resection followed by intravesical BCG therapy. An autopsy was performed due to the sudden nature of his death. Autopsy showed multiple necrotizing granulomas in the brain, atrium, ventricles, lungs, kidneys, and urinary bladder. Stains for acid-fast bacilli and fungi were negative. In addition, bilateral lungs showed evidence of bronchopneumonia secondary to cytomegalovirus. CONCLUSION Granulomatous myocarditis arising from BCG therapy is extremely rare. Our patient with urothelial cancer treated with BCG developed multiorgan granulomas, most likely due to a hypersensitivity reaction to intravesical BCG. Arrhythmia induced by granulomatous myocarditis was the cause of his death. Although there have been few cases of systemic BCG-osis causing fatal sepsis leading to death, a cardiac cause of death is unique.
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Affiliation(s)
- Saroja D Geetha
- Northwell Health, Department of Pathology, Zucker School of Medicine, North Shore University Hospital/Long Island Jewish Medical Center, 2200 Northern Blvd, Suite 104, Greenvale, NY, 11548, USA.
| | - Hector D Chavarria
- Northwell Health, Department of Pathology, Zucker School of Medicine, North Shore University Hospital/Long Island Jewish Medical Center, 2200 Northern Blvd, Suite 104, Greenvale, NY, 11548, USA
| | - Mohammed Abdelwahed
- Northwell Health, Department of Pathology, Zucker School of Medicine, North Shore University Hospital/Long Island Jewish Medical Center, 2200 Northern Blvd, Suite 104, Greenvale, NY, 11548, USA
| | - Nidhi Kataria
- Northwell Health, Department of Pathology, Zucker School of Medicine, North Shore University Hospital/Long Island Jewish Medical Center, 2200 Northern Blvd, Suite 104, Greenvale, NY, 11548, USA
| | - Vanesa Bijol
- Northwell Health, Department of Pathology, Zucker School of Medicine, North Shore University Hospital/Long Island Jewish Medical Center, 2200 Northern Blvd, Suite 104, Greenvale, NY, 11548, USA
| | - Kasturi Das
- Northwell Health, Department of Pathology, Zucker School of Medicine, North Shore University Hospital/Long Island Jewish Medical Center, 2200 Northern Blvd, Suite 104, Greenvale, NY, 11548, USA
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Jolobe OM. High-risk and low prevalence disease: Cardiac sarcoidosis and some of its mimics. IJC HEART & VASCULATURE 2023; 47:101221. [PMID: 37252195 PMCID: PMC10209807 DOI: 10.1016/j.ijcha.2023.101221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
In this narrative review of cardiac sarcoidosis, based on a literature search using the terms "cardiac sarcoidosis", "tuberculous myocarditis", "Whipple's disease and myocarditis", and"idiopathic giant cell myocarditis", I have defined cardiac sarcoidosis as a disorder which can be diagnosed either by documentation of the presence of sarcoid-related granulomas in myocardial tissue or by documentation of the association of the presence of sarcoid-related granulomas in extracardiac tissue and symptoms such as complete heart block, ventricular tachyarrhythmia, sudden death or dilated cardiomyopathy which are typical of cardiac sarcoidosis. The differential diagnosis of cardiac sarcoidosis includes granulomatous myocarditis attributable to underlying causes such as such as tuberculosis, Whipple's disease, and idiopathic giant cell myocarditis. Diagnostic pathways for cardiac sarcoidosis include biopsy of cardiac and extracardiac tissue, nuclear magnetic resonance imaging, positron emission tomography, and a diagnostic trial of empiric therapy. Problem areas include differentiation between noncaseating granulomatosis attributable to sarcoidosis versus noncaseating granulomatosis attributable to tuberculosis and whether or not the workup of suspected cardiac sarcoidosis should always include evaluation of biopsy tissue by molecular methods for M tuberculosis DNA as well as by mycobacterium tuberculosis culture. The diagnostic significance of necrotising granulomatosis is also unclear. Evaluation of patients on long term immunotherapy should also take due account of the risk of tuberculosis attributable to the use of tumor necrosis factor-alpha antagonists.
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Affiliation(s)
- Oscar M.P. Jolobe
- Address: Flat 6 Souchay Court, 1 Clothorn Road, Manchester M20 6BR, United Kingdom.
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Kumar S, Narasimhan C. Diagnosis and management of Granulomatous Myocarditis. Indian Pacing Electrophysiol J 2022; 22:179-181. [PMID: 35777855 DOI: 10.1016/j.ipej.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Sharath Kumar
- Department of Electrophysiology, Asian Institute of Gastroenterology, Gachibowli, Hyderabad, India
| | - Calambur Narasimhan
- Department of Electrophysiology, Asian Institute of Gastroenterology, Gachibowli, Hyderabad, India.
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