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Spisarova M, Losse S, Jakubec P, Hartmann I, Kral M, Ehrmann J, Szkorupa M, Studentova H, Melichar B. Bacillus Calmette-Guérin pneumonitis after intravesical instillation: Report of two cases and a review of the literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:181-186. [PMID: 36628562 DOI: 10.5507/bp.2022.051] [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: 10/28/2022] [Accepted: 12/01/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Intravesical administration of bacillus Calmette-Guérin is standard adjuvant treatment of non-muscle invasive bladder cancer. In spite of the fact that this immunotherapy is locoregional, there are still risk of some complications. METHODS We describe two cases of systemic BCG infection after intravesical administration of BCG vaccine in patients with early stage of bladder cancer. RESULTS Both patients suffered from systemic BCG infection manifesting as BCG pneumonitis. After standard therapy with antituberculotic agents, both of them fully recovered. CONCLUSION BCG infection can occur as a rare but potentially serious complication of this treatment procedure. Gravity of this side effect and its specific therapy require prompt and right diagnosis.
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Affiliation(s)
- Martina Spisarova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Stanislav Losse
- Department of Pneumology and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Jakubec
- Department of Pneumology and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Igor Hartmann
- Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Milan Kral
- Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jiri Ehrmann
- Institute of Molecular and Clinical Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Marek Szkorupa
- 1st Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Hana Studentova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
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Prudhomme T, Andras I, Boissier R, Campi R, Hevia V, Territo A, Kidney Transplant Group EAOUYAU. Endovesical Bacillus Calmette-Guérin for Nonmuscle Invasive Bladder Cancer in Kidney Transplant Recipients: Is It Safe and Efficacious? EXP CLIN TRANSPLANT 2022; 20:789-791. [DOI: 10.6002/ect.2022.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jue JS, Alameddine M, Gonzále J, Cianci G. Risk factors, management, and survival of bladder cancer after kidney transplantation. Actas Urol Esp 2021; 45:427-438. [PMID: 34147429 DOI: 10.1016/j.acuroe.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation. MATERIALS AND METHODS A systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed. RESULTS A total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%). CONCLUSIONS Carcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops.
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Affiliation(s)
- J S Jue
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - M Alameddine
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Gonzále
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - G Cianci
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Alkassis M, Abi Tayeh G, Khalil N, Mansour R, Lilly E, Sarkis J, Moukarzel M. The safety and efficacy of Bacillus Calmette-Guerin intravesical therapy in kidney transplant recipients with superficial bladder cancer. Clin Transplant 2021; 35:e14377. [PMID: 34050983 DOI: 10.1111/ctr.14377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/09/2021] [Accepted: 05/24/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Marwan Alkassis
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Georges Abi Tayeh
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Nour Khalil
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Raymond Mansour
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Eddy Lilly
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Julien Sarkis
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Maroun Moukarzel
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
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Jue J, Alameddine M, González J, Ciancio G. Risk factors, management, and survival of bladder cancer after kidney transplantation. Actas Urol Esp 2021. [PMID: 33994047 DOI: 10.1016/j.acuro.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation. MATERIALS AND METHODS A systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed. RESULTS A total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%). CONCLUSIONS Carcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops.
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Shimizu G, Amano R, Nakamura I, Wada A, Kitagawa M, Toru S. Disseminated Bacillus Calmette-Guérin (BCG) infection and acute exacerbation of interstitial pneumonitis: an autopsy case report and literature review. BMC Infect Dis 2020; 20:708. [PMID: 32993546 PMCID: PMC7523392 DOI: 10.1186/s12879-020-05396-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Intravesical administration of Bacillus Calmette–Guérin (BCG) has proven useful for treatment and prevention of recurrence of superficial bladder cancer and in situ carcinoma. However, fatal side effects such as disseminated infections may occur. Early diagnosis and accurate therapy for interstitial pneumonitis (IP) are important because exacerbation of IP triggered by infections is the major cause of death. Although some fatality reports have suggested newly appeared IP after intravesical BCG treatment, to our knowledge, there are no reports which have demonstrated acute exacerbation of existing IP. Moreover, autopsy is lacking in previous reports. We report the case of a patient with fatal IP exacerbation after BCG instillation and the pathological findings of the autopsy. Case presentation A 77-year-old man with a medical history of IP was referred to our hospital because of fever and malaise. He had received an intravesical injection of BCG 1 day before the admission. His fever reduced after the use of antituberculosis drugs, so he was discharged home. He was referred to our hospital again because of a high fever 7 days after discharge. On hospitalisation, he showed high fever and systemic exanthema. Hepatosplenomegaly and myelosuppression were also observed. Biopsies revealed multiple epithelioid cell granulomas with Langhans giant cells of the liver and bone marrow. Biopsy DNA analyses of Mycobacterium bovis in the bone marrow, sputum, and blood were negative. His oxygen demand worsened drastically, and the ground-glass shadow expanded on the computed tomography scan. He was diagnosed with acute exacerbation of existing IP. We recommenced the antituberculosis drugs with steroid pulse therapy, but he died on day 35 because of respiratory failure. The autopsy revealed a diffuse appearance of multiple epithelioid cell granulomas with Langhans giant cells in multiple organs, although BCG was not evident. Conclusions We report the first case of acute exacerbation of chronic IP by BCG infection. This is also the first case of autopsy of a patient with acute exacerbation of existing IP induced by intravesical BCG treatment. Whether the trigger of acute IP exacerbation is infection or hypersensitivity to BCG is still controversial, because pathological evidence confirming BCG infection is lacking. Physicians who administer BCG against bladder cancer should be vigilant for acute exacerbation of IP.
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Affiliation(s)
- Gen Shimizu
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano-ku, Tokyo, 164-8607, Japan
| | - Ryota Amano
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano-ku, Tokyo, 164-8607, Japan.
| | - Itaru Nakamura
- Department of Infection Prevention and Control, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Akane Wada
- Department of Oral Pathology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Masanobu Kitagawa
- Department of Comprehensive Pathology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Shuta Toru
- Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo Nakano-ku, Tokyo, 164-8607, Japan
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