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Audenet F, Sotto A, Roumiguié M, Allory Y, Andrejak C, Leon P, Loriot Y, Masson-Lecomte A, Pradère B, Seisen T, Traxer O, Xylinas E, Bruyère F, Roupret M, Saint F, Neuzillet Y. Recommandations des Comités de cancérologie (CC-AFU) et d’infectiologie (CI-AFU) de l’Association française d’urologie pour la prise en charge effets indésirables et complications du BCG. Prog Urol 2022; 32:165-176. [DOI: 10.1016/j.purol.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
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Bajramovic S, Alic J, Skopljak E, Chikha A, Vesnic S, Smajilbegovic V, Aganovic D. Renal Tuberculosis Following Intravesical Bacillus Calmette-Guérin (BCG) Immunotherapy for the Treatment of Bladder Cancer. Med Arch 2020; 74:146-150. [PMID: 32577059 PMCID: PMC7296402 DOI: 10.5455/medarh.2020.74.146-150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Non-muscle-invasive bladder cancer (NMIBC) is usually effectively treated with transurethral resection (TUR), most often followed by intravesical instillation of bacillus Calmette-Guérin (BCG) or intravesical chemotherapy. Although the precise mechanism of BCG immunotherapy is still unclear, a local immune response is presumed. However, a number of severe side effects and complications are related to intravesical immunotherapy. AIM: Aim of this report is to present rare case of the renal granulomatous disease in a patient previously treated with intravesical instillation of BCG immunotherapy, following TURBT. In addition, we performed review of previously reported cases of renal granulomas following intravesical BCG immunotherapy. Case report: A 79-year-old man was presented to Urology Clinic due to clinically verified tumor of the urinary bladder. After transurethral resection of bladder tumor, histopathological analysis revealed the diagnosis of papillary urothelial high-grade pT1 carcinoma. Intravesical BCG immunotherapy was initiated, according to protocol currently used in our institution. Upon completion of therapy with BCG, we re-examined the patient and, using ultrasound, found a change in the right kidney, resembling moth bites not seen on CT scan before TURBT. Additionally, CT-guided core-needle biopsy of the affected kidney was performed, and the specimen was sent for histopathological analysis, which revealed chronic necrotizing granulomatous inflammation. Antituberculotic therapy was initiated for 6 months. Upon completion of antituberculotic therapy, control CT-scan was performed at follow-up, indicating regression of changes on the right kidney. Conclusion: This case report emphasizes the importance of consistent implementation of follow-up protocol and the identification of lesions during the asymptomatic period and enables the proper treatment of the disease. To reduce the incidence of adverse effects of BCG treatment for bladder tumors, an individualized approach is needed.
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Affiliation(s)
- Senad Bajramovic
- Urology Clinic, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Medical Faculty, University Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Jasmin Alic
- Urology Clinic, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edna Skopljak
- Medical Faculty, University Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Adisa Chikha
- Institute of Pathology, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sanela Vesnic
- Insitute of Radiology, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Velda Smajilbegovic
- Oncology Clinic, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Damir Aganovic
- Urology Clinic, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Immunotherapy. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pommier JD, Ben Lasfar N, Van Grunderbeeck N, Burdet C, Laouénan C, Rioux C, Pierre-Audigier C, Meybeck A, Choudat L, Benchikh A, Nguyen S, Bouvet E, Yeni P, Yazdanpanah Y, Joly V. Complications following intravesical bacillus Calmette-Guerin treatment for bladder cancer: a case series of 22 patients. Infect Dis (Lond) 2015; 47:725-31. [PMID: 26077036 DOI: 10.3109/23744235.2015.1055794] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intravesical bacillus Calmette-Guerin (BCG) therapy is an effective and widely used treatment for superficial bladder carcinoma. Local complications are frequent whereas systemic complications are rare but can be serious, and their management is not well known. METHODS We describe retrospectively the records of 22 patients treated in 3 infectious disease departments, for complications related to intravesical BCG therapy as treatment of bladder cancer. RESULTS All the patients were male, with a median age of 68 years (range 56-88). Complications occurred after a median of 5 instillations (range 1-11) and were observed within 24 h following BCG instillation for 14 patients. Common symptoms were fever (n = 20), impaired general condition (n = 14), and shortness of breath (n = 7). Six patients had a systemic septic reaction leading to transfer into the intensive care unit for five of them. Lung infiltration was the most frequent presentation (n = 11). Mycobacterium bovis was isolated from only two patients, but histology showed the presence of a granuloma in nine patients. Antimycobacterial treatment was initialized in 17 patients; the outcome was favorable in 16 patients, with a median length of symptoms resolution of 22.5 days (range 5-425 days). Eleven patients received corticosteroids in addition to specific treatment and had a more rapid improvement. One patient died with disseminated BCGitis proved by biopsy. CONCLUSIONS Complications following intravesical BCG therapy are rare but can be severe and fatal. Histology seems to be the method that contributes most in confirmation of the diagnosis. Antimycobacterial therapy is effective, and probably more efficient when combined with corticosteroids, but the regimen and duration of the treatment are not standardized.
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Affiliation(s)
- J D Pommier
- Infectious and Tropical Diseases Department, Bichat Hospital, AP-HP , Paris , France
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Pérez-Jacoiste Asín MA, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Tejido Á, San Juan R, Arrebola-Pajares A, Lizasoain M, Prieto S, Aguado JM. Bacillus Calmette-Guérin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: incidence, risk factors, and outcome in a single-institution series and review of the literature. Medicine (Baltimore) 2014; 93:236-254. [PMID: 25398060 PMCID: PMC4602419 DOI: 10.1097/md.0000000000000119] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Bacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0-9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p < 0.001 for all comparisons). Attributable mortality was higher for patients aged ≥65 years (7.4% vs 2.1%; p = 0.091) and those with disseminated infection (9.9% vs 3.0%; p = 0.040) and vascular involvement (16.7% vs 4.6%; p = 0.064). The scheduled BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy.
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Affiliation(s)
- María Asunción Pérez-Jacoiste Asín
- Unit of Infectious Diseases (MAPJA, MFR, FLM, CL, RSJ, ML, JMA), Department of Urology (AT, AAP), and Department of Internal Medicine (SP), Hospital Universitario "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain
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Detection of bacillus Galmette-Guérin (Mycobacterium bovis BCG) DNA in urine and blood specimens after intravesical immunotherapy for bladder carcinoma. J Clin Microbiol 2011; 49:1206-8. [PMID: 21270226 DOI: 10.1128/jcm.01595-10] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A real-time PCR targeting IS6110 was employed for the detection of Mycobacterium tuberculosis DNA in specimens collected from 10 patients treated with intravesical M. bovis bacillus Galmette-Guérin (BCG) immunotherapy for bladder malignancy. BCG DNA was detected in all urine specimens taken 24 h after the instillations, as well as in 24% of the specimens collected 7 days after the instillations; it was also detected in a single specimen taken 6 weeks after the last instillation. BCG DNA was detected in 8.3% of the blood specimens taken 1 day after instillation, and its amplification was associated with cases of self-limiting fever. These findings give indications that this real-time PCR is helpful to recognize BCG bacteremic cases, which may lead to mycobacterial infection.
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Somoskovi A, Carlyn C, Dormandy J, Salfinger M. Mediastinal mass mimicking a tumor in a patient with bladder cancer after Bacillus Calmette-Guerin treatment. Eur J Clin Microbiol Infect Dis 2007; 26:937-40. [PMID: 17899227 DOI: 10.1007/s10096-007-0390-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We describe the case of a 78-year-old male with bladder cancer who developed a mediastinal mass after intravesical immunotherapy with live Mycobacterium bovis BCG. The clinical diagnosis was mediastinal tumor suggestive for lymphoma. However, cultures of the biopsy specimens grew an acid-fast organism, which was identified as M. bovis BCG. To the best of our knowledge, this is the first reported case in which a post-instillation BCG infection induced a mediastinal mass that mimicked a tumor in a patient with bladder cancer.
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Affiliation(s)
- A Somoskovi
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
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Fernández Cañabate E, Longoni Merino M. [Systemic infection secondary to intravesical BCG instillation]. FARMACIA HOSPITALARIA 2007; 30:317-9. [PMID: 17166070 DOI: 10.1016/s1130-6343(06)74000-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Petrini B, Häggarth L, Stiernstedt SH. Early PCR detection of Bacille Calmette-Guérin complications in bladder cancer therapy. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2002; 34:233-4. [PMID: 12030406 DOI: 10.1080/00365540110077371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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INDUCTION OF MYCOBACTEREMIA BY INTRAVESICAL BACILLUS CALMETTE-GUERIN INSTILLATION IN AN EXPERIMENTAL ANIMAL MODEL AND DETECTION WITH POLYMERASE CHAIN REACTION. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Page J, Hawes-Davis D, Mitchem R, Severance MS. Case of the season. Miliary pulmonary granulomatous disease. Secondary to BCG immunotherapy. Semin Roentgenol 1999; 34:165-8. [PMID: 10432546 DOI: 10.1016/s0037-198x(99)80031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J Page
- Department of Radiology, Capital Region Medical Center, Jefferson City, MO 65101, USA
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Abstract
Bladder tumor antigen, nuclear matrix protein 22, telomerase activity, fibrin degradation products assay, and a number of diagnostic tests on exfoliated urethelial cells are being tried to replace or decrease the frequency of cystoscopies. The results of these studies have shown that although some of these tests are promising, the standard of care for patients with hematuria or previously treated bladder carcinoma is still cystoscopy. New and non-invasive tests are on the horizon, however. It is essential to find accurate prognostic factors in patients with T1 disease which will predict the cases which will progress to muscle invasive disease. It has been clearly shown that the depth of invasion within the submucosa is closely related with survival. It has been established that continent diversions improve the quality of life in patients who have undergone cystectomy. Furthermore, this type of diversion was shown to improve survival. This fact can be attributed to early cystectomy which was prompted by the increased patient acceptance.
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Affiliation(s)
- H Ozen
- Department of Urology, Hacettepe University, Ankara, Turkey
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