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Peng Y, Song Y, Du Y, Qin C, Xu T. Comparative analysis of adverse events among intravesical drugs in bladder cancer: a real-world study on FAERS database. Expert Opin Drug Saf 2024; 23:1207-1214. [PMID: 38946478 DOI: 10.1080/14740338.2024.2374921] [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: 04/29/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Intravesical therapy is a commonly utilized treatment for non-muscle invasive bladder cancer (NMIBC). This study focuses on summarizing the signals of all intravesical drugs and aims to highlight the comprehensive differences in adverse events (AEs) between these drugs. RESEARCH DESIGN AND METHODS We conducted pharmacovigilance data analysis based on the real-world big data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database. RESULTS We elucidated all signals compared with the overall FAERS database or other administration routes for Bacillus Calmette-Guerin (BCG), mitomycin, gemcitabine, valrubicin, and epirubicin. Notably, the distribution of reported AEs associated with intravesical therapy exhibited a noticeable inclination toward male patients. Furthermore, all five drugs demonstrated a disproportionate distribution in local AEs, particularly in renal and urinary disorders. Additionally, specific signals and findings were summarized for each individual drug. Finally, we highlighted the AEs that resulted in serious outcomes for each drug. CONCLUSION We have compiled an overview of the AEs tied to intravesical drugs whilst considering their individual distinctions. These insightful findings serve to enrich our comprehension of the safety profiles and potential risks linked to intravesical therapy.
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Affiliation(s)
- Yun Peng
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yuxuan Song
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yiqing Du
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Caipeng Qin
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
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Nishimura M, Okumura M, Takemasa T, Yoshiyama T, Tanaka Y, Saotome M, Ohta K. A case of disseminated M. bovis bacillus Calmette-Guérin (BCG) disease after one month of BCG bladder infusion therapy and analysis of 77 cases of suspected BCG infection in Japan, 2017-2022. Respir Med Case Rep 2023; 45:101902. [PMID: 37538979 PMCID: PMC10393993 DOI: 10.1016/j.rmcr.2023.101902] [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: 12/19/2022] [Revised: 03/31/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
Bacillus Calmette-Guerin (BCG) intravesical injections are used as adjuvant therapy for superficial bladder cancer. We report a case of a 78-year-old man who developed disseminated M. bovis BCG disease mimicking miliary tuberculosis early after BCG intravesical infusion. He started coughing after receiving three rounds of BCG for superficial bladder tumors, following transurethral resection of the tumors, approximately one month after initiation. Computerized tomography (CT) images showed diffuse nodular shadows in the bilateral lung fields with a random pattern. Consequently, disseminated BCG disease was diagnosed. Treatment with isoniazid, rifampicin, and ethambutol was initiated. Nine months after initiating treatment, CT showed the disappearance of the miliary shadows. We also discussed 77 cases of suspected BCG infection and the requests for Mycobacterium bovis BCG identification at our institution from 2017 to October 2022. Of these, 76 cases were M. bovis BCG, and 1 case was M. tuberculosis. Since M. tuberculosis can be identified in some patients with suspected BCG infection, it is crucial to distinguish between the two based on pathogenicity.
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Affiliation(s)
- Masashi Nishimura
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Masao Okumura
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Takii Takemasa
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Japan
| | - Takashi Yoshiyama
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Yoshiaki Tanaka
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Mikio Saotome
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Ken Ohta
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
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Roe JM, Seely K, Bussard CJ, Eischen Martin E, Mouw EG, Bayles KW, Hollingsworth MA, Brooks AE, Dailey KM. Hacking the Immune Response to Solid Tumors: Harnessing the Anti-Cancer Capacities of Oncolytic Bacteria. Pharmaceutics 2023; 15:2004. [PMID: 37514190 PMCID: PMC10384176 DOI: 10.3390/pharmaceutics15072004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Oncolytic bacteria are a classification of bacteria with a natural ability to specifically target solid tumors and, in the process, stimulate a potent immune response. Currently, these include species of Klebsiella, Listeria, Mycobacteria, Streptococcus/Serratia (Coley's Toxin), Proteus, Salmonella, and Clostridium. Advancements in techniques and methodology, including genetic engineering, create opportunities to "hijack" typical host-pathogen interactions and subsequently harness oncolytic capacities. Engineering, sometimes termed "domestication", of oncolytic bacterial species is especially beneficial when solid tumors are inaccessible or metastasize early in development. This review examines reported oncolytic bacteria-host immune interactions and details the known mechanisms of these interactions to the protein level. A synopsis of the presented membrane surface molecules that elicit particularly promising oncolytic capacities is paired with the stimulated localized and systemic immunogenic effects. In addition, oncolytic bacterial progression toward clinical translation through engineering efforts are discussed, with thorough attention given to strains that have accomplished Phase III clinical trial initiation. In addition to therapeutic mitigation after the tumor has formed, some bacterial species, referred to as "prophylactic", may even be able to prevent or "derail" tumor formation through anti-inflammatory capabilities. These promising species and their particularly favorable characteristics are summarized as well. A complete understanding of the bacteria-host interaction will likely be necessary to assess anti-cancer capacities and unlock the full cancer therapeutic potential of oncolytic bacteria.
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Affiliation(s)
- Jason M Roe
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA
| | - Kevin Seely
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA
| | - Caleb J Bussard
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO 80130, USA
| | | | - Elizabeth G Mouw
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA
| | - Kenneth W Bayles
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Michael A Hollingsworth
- Eppley Institute for Cancer Research, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Amanda E Brooks
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO 80130, USA
- Office of Research & Scholarly Activity, Rocky Vista University, Ivins, UT 84738, USA
| | - Kaitlin M Dailey
- Eppley Institute for Cancer Research, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Culture-proven disseminated Mycobacterium Bovis infection (BCG-Osis) following intravesical BCG immunotherapy in a patient with bladder carcinoma-in-situ: ‘Case report’. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00270-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractWe are reporting a case of culture-proven disseminated Mycobacterium Bovis infection (BCG-Osis), involving lung, bone-marrow and urinary tract, after intravesical Bacillus Calmette–Guérin (BCG) immunotherapy for bladder carcinoma-in-situ. A 71-year-gentleman presented with fever shortly after intravesical BCG instillation. He was initially treated for presumed Urinary Tract Infection, but negative urine culture and persistent fever prompted us to consider alternative diagnoses. Empirical treatment for BCG-Osis was commenced after initial negative workup including blood culture, echocardiography, computed tomography (CT) Chest, and Kidney-Ureter-Bladder (KUB). However, he remained febrile and leukopenic, so bone-marrow examination was performed along with repeating CT Chest, which revealed non-caseating granulomas and small nonspecific pulmonary nodules, respectively, supporting our provisional diagnosis. Interestingly, Mycobacterium Bovis was finally isolated from one of his urine specimens, confirming our diagnosis.
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Clinical Features of Tuberculosis Pseudoaneurysm and Risk Factors for Mortality. J Vasc Surg 2021; 75:1729-1738.e2. [PMID: 34788648 DOI: 10.1016/j.jvs.2021.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/24/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The objective of this study was to determine the clinical features of tuberculosis aneurysms and risk factors for mortality. MATERIALS AND METHOD We reviewed all case reports of tuberculous aneurysms in the English literature from January 2000 to December 2020. The clinical features and possible risk factors for mortality were recorded and analyzed. RESULT In total, 174 cases of tuberculosis aneurysms were identified. The morbidity of men was more than twice that of women. Male patients (51.47±20.67 years) were older than female patients (39.52±20.23 years), p<0.05. The rupture rate of women (69.2%) was higher than that of men (48.8%). TB-induced aneurysms often spontaneously ruptured 1.41-3.01 months after the onset of TB symptoms without any treatment, and Bacillus Calmette-Guerin (BCG)-induced aneurysms often spontaneously ruptured 10.51-26.49 months after BCG administration. The morbidity of large artery aneurysms was nearly twice that of middle artery aneurysms. However, middle artery aneurysms were more likely to rupture (75.4%) than large artery aneurysms (43.5%), p<0.05. The rupture rate of BCG-induced aneurysms (37.0%) was lower than that of TB-induced aneurysms, regardless of whether there was a TB history (56.7%) or not (57.7%). Symptoms of TB occurred in 63.2% of patients, but only 8.6% of patients had both symptoms of TB and aneurysmal mass effects. Pain was the most common atypical clinical manifestation (50.0%). The Cox proportional hazards regression analysis and Kaplan-Meier estimator showed that rupture and no combined therapy were risk factors for mortality. CONCLUSION Tuberculosis aneurysms seemingly shared the same demographic characteristics as common aneurysms. The clinical features of TB-induced aneurysms were different from those of BCG-induced aneurysms in terms of the aneurysm loactation and rupture rate. Tuberculosis aneurysms may occur at any site of the cardiovascular system with a preponderance for large arteries. The changeable clinical manifestations were an important index for diagnosis, but focusing only on clinical manifestations may lead to a missed diagnosis. The combination of anti-TB medications and surgery before aneurysm rupture may provide the best prognosis.
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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.
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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
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Sun K, Wang D, Wu G, Ma J, Wang T, Wu J, Wang J. Mirabegron improves the irritative symptoms caused by BCG immunotherapy after transurethral resection of bladder tumors. Cancer Med 2021; 10:7534-7541. [PMID: 34547193 PMCID: PMC8559481 DOI: 10.1002/cam4.4278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to explore the efficacy and safety of mirabegron in treating irritative symptoms induced by intravesical immunotherapy with Bacillus Calmette-Guerin (BCG) after transurethral resection of bladder tumors (TURBT). METHODS A total of 160 patients subjected to TURBT was randomly divided into the mirabegron group and placebo group with 80 patients in each group. Then, the patients were administered 25 mg mirabegron or placebo daily, starting the first day after BCG infusion. The first BCG perfusion was conducted at least 2 weeks after TURBT. The 3-day bladder diaries were completed in all patients, 1 day before BCG perfusion, and on the 1st, 6th, and 13th days after the first BCG perfusion. Overactive bladder symptom scores were completed 1 day before BCG perfusion, and on the 6th and 13th days after the first BCG perfusion. RESULTS Symptom scores of bladder hyperactivity were significantly different between the two groups (p < 0.001). Also, the frequency of nocturia, pollakiuria, micturition urgency, urinary incontinence and was significantly lower in group 1 than that in group two (p < 0.05). CONCLUSION Our findings demonstrate that mirabegron is a valuable clinical drug for the management of irritative symptoms after TURBT with subsequent intravesical BCG perfusion.
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Affiliation(s)
- Kai Sun
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Di Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Gang Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Jian Ma
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Tianqi Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Jipeng Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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Effectiveness of Steroid Pulse Therapy for Systemic Side Effects after Bacillus Calmette-Guérin Intravesical Instillation Therapy: A Series of Five Cases. Case Rep Urol 2021; 2021:5548054. [PMID: 34336352 PMCID: PMC8286186 DOI: 10.1155/2021/5548054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Bacillus Calmette-Guérin (BCG) instillation is an established therapy for the treatment of carcinoma in situ (CIS) of the bladder and prevention of recurrence after transurethral resection of bladder tumor noninvasive bladder cancer. However, serious systemic side effects may occur in less than 5% of patients with BCG intravesical instillation. Systemic side effects can sometimes be fatal and require early and accurate treatment. We describe five cases wherein steroid pulse therapy was effective for treating the systemic side effects after BCG intravesical instillation. Case Presentations. BCG intravesical instillation was used to prevent the recurrence of nonmuscle invasive bladder cancer and treat CIS of the bladder; the dose used was 40–80 mg each time, and the Tokyo strain was used. The patients developed fever, impaired consciousness, arthralgia, conjunctival hyperemia, and symptoms of cystitis. The median time from installation to side effect manifestation was 6 days (0–8). One to two courses of steroid pulse therapy were administered (1 course in 3 days), and the dose of methylprednisolone was 500–1000 mg/day. BCG sepsis was observed in one case; however, in the other four cases, one course of steroid pulse therapy showed a rapid improvement in symptoms. In the case of BCG sepsis, hemodialysis and mechanical ventilation were required because of septic shock and acute renal failure. Antituberculosis drugs (isoniazid, rifampicin, and ethambutol) were started promptly; however, no improvement was noticed. Two courses of steroid pulse therapy improved the patient's general condition, and hemodialysis and mechanical ventilation were no longer required. All patients survived without relapse of symptoms. Conclusion Our cases suggest that early steroid pulse therapy may be effective for rapid symptom improvement of the systemic side effects of BCG instillation therapy.
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Itai M, Yamasue M, Takikawa S, Komiya K, Takeno Y, Igarashi Y, Takeshita Y, Hiramatsu K, Mitarai S, Kadota JI. A solitary pulmonary nodule caused by Mycobacterium tuberculosis var. BCG after intravesical BCG treatment: a case report. BMC Pulm Med 2021; 21:115. [PMID: 33827514 PMCID: PMC8028358 DOI: 10.1186/s12890-021-01475-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Intravesical instillation of bacillus Calmette–Guérin (BCG) as a treatment for superficial bladder cancer rarely causes pulmonary complications. While published cases have been pathologically characterized by multiple granulomatous lesions due to disseminated infection,
no case presenting as a solitary pulmonary nodule has been reported. Case presentation A man in his 70 s was treated with intravesical BCG for early-stage bladder cancer. After 1 year, he complained of productive cough with a solitary pulmonary nodule at the left lower lobe of his lung being detected upon chest radiography. His sputum culture result came back positive, with conventional polymerase chain reaction (PCR) identifying Mycobacterium tuberculosis complex. However, tuberculosis antigen-specific interferon-gamma release assay came back negative. Considering a history of intravesical BCG treatment, multiplex PCR was conducted, revealing the strain to be Mycobacterium tuberculosis var. BCG. The patient was then treated with isoniazid, ethambutol, levofloxacin, and para-aminosalicylic acid following an antibiotic susceptibility test showing pyrazinamide resistance, after which the size of nodule gradually decreased. Conclusion This case highlights the rare albeit potential radiographic presentation of Mycobacterium tuberculosis var. BCG, showing a solitary pulmonary nodule but not multiple granulomatous lesions, after intravesical BCG treatment. Differentiating Mycobacterium tuberculosis var. BCG from Mycobacterium tuberculosis var. tuberculosis is crucial to determine whether intravesical BCG treatment could be continued for patients with bladder cancer.
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Affiliation(s)
- Mariko Itai
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan
| | - Mari Yamasue
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan.,Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Shuichi Takikawa
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan
| | - Kosaku Komiya
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan. .,Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Yukiko Takeno
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan.,Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yuriko Igarashi
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24, Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Yasushi Takeshita
- Department of Internal Medicine, Tsukumi Chuo Hospital, 6011 Chinu, Tsukumi, Tsukumi, Oita, 879-2401, Japan
| | - Kazufumi Hiramatsu
- Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Satoshi Mitarai
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24, Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
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Waked R, Choucair J, Chehata N, Haddad E, Saliba G. Intravesical Bacillus Calmette-Guérin (BCG) treatment's severe complications: A single institution review of incidence, presentation and treatment outcome. J Clin Tuberc Other Mycobact Dis 2020; 19:100149. [PMID: 32099909 PMCID: PMC7016447 DOI: 10.1016/j.jctube.2020.100149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Intravesical Bacillus Calmette-Guérin (BCG) treatment for superficial bladder cancer is interrupted in approximatively 8% of cases as a result of complications. The objective is to report the severe related complications of Bacillus Calmette-Guérin (BCG) following an intravesical instillation for bladder tumor encountered at our institution for the past 5 years. METHODS Medical records of a tertiary teaching hospital, located in Beirut, Lebanon, were retrospectively analyzed from June 2014 to June 2019 searching for severe related complications of BCG. A comprehensive review of articles on this subject was conducted. RESULTS The incidence of severe systemic adverse events related to BCG instillation was 1.5% (5 out of 332 patients). A total of five patients were found to have a severe BCG related complication, with fever, chills, and irritative urinary signs being the most frequent symptoms. All patients received antituberculosis therapy (Isoniazid, Rifampin and Ethambutol). Two were put on add-on corticosteroids. Three patients had a computed tomography scan image in favor of an infection. Two patients had a favorable outcome, three patients died. CONCLUSION BCG severe adverse events were mostly seen in patients with a traumatic instillation. Treatment used at our institution was similar to most cases reported in the literature. A standardized diagnostic and treatment approach should be implemented to help physicians tackle these life-threatening complications.
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Affiliation(s)
- R. Waked
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
| | - J. Choucair
- Coordinator of the Infectious Diseases department, Saint Joseph University, Beirut, Lebanon
| | - N. Chehata
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
| | - E. Haddad
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
| | - G. Saliba
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Damascus street, PO BOX 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon
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11
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Marques M, Vazquez D, Sousa S, Mesquita G, Duarte M, Ferreira R. Disseminated Bacillus Calmette-Guérin (BCG) infection with pulmonary and renal involvement: A rare complication of BCG immunotherapy. A case report and narrative review. Pulmonology 2019; 26:346-352. [PMID: 31711964 DOI: 10.1016/j.pulmoe.2019.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 11/29/2022] Open
Abstract
Intravesical Bacillus Calmette-Guérin (BCG) instillation is a mainstay of adjunctive therapy for superficial bladder cancer that increases length of disease progression-free survival. Although usually well tolerated, moderate to severe local and systemic infectious complications can occur with this immunotherapy. Diagnosis is difficult and often based on high clinical suspicion since in many cases Mycobacterium bovis is not isolated. Treatment is not fully standardized but the combination of anti-tuberculosis drugs and corticosteroids is advocated in severe cases. The authors present an unusual case of a severe infectious complication following intravesical BCG instillation with pulmonary and kidney involvement. Prompt anti-tuberculosis treatment associated to corticosteroid resulted in a marked clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection. Based on this, the authors aimed to review the literature on this exceptional complication of this immunotherapy.
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Affiliation(s)
- Marta Marques
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal.
| | - Dolores Vazquez
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
| | - Susana Sousa
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
| | - Gonçalo Mesquita
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
| | - Maria Duarte
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
| | - Rosa Ferreira
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal
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Abstract
BCG immunotherapy is the gold-standard treatment for non-muscle-invasive bladder cancer at high risk of recurrence or progression. Preclinical and clinical studies have revealed that a robust inflammatory response to BCG involves several steps: attachment of BCG; internalization of BCG into resident immune cells, normal cells, and tumour urothelial cells; BCG-mediated induction of innate immunity, which is orchestrated by a cellular and cytokine milieu; and BCG-mediated initiation of tumour-specific immunity. As an added layer of complexity, variation between clinical BCG strains might influence development of tumour immunity. However, more than 40 years after the first use of BCG for bladder cancer, many questions regarding its mechanism of action remain unanswered. Clearly, a better understanding of the mechanisms underlying BCG-mediated tumour immunity could lead to improved efficacy, increased tolerance of treatment, and identification of novel immune-based therapies. Indeed, enthusiasm for bladder cancer immunotherapy, and the possibility of combining BCG with other therapies, is increasing owing to the availability of targeted immunotherapies, including checkpoint inhibitors. Understanding of the mechanism of action of BCG immunotherapy has advanced greatly, but many questions remain, and further basic and clinical research efforts are needed to develop new treatment strategies for patients with bladder cancer.
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Favorable Outcome in a Patient with Systemic BCGitis After Intra-bladder Instillation of Calmette-Guerin Bacillus Highlighting the Importance of Making the Correct Diagnosis in this Rare Form of Sepsis. J Transl Int Med 2019; 7:34-38. [PMID: 30997355 PMCID: PMC6463824 DOI: 10.2478/jtim-2019-0007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We present the case of a patient with sepsis following a traumatic intra-bladder instillation of Calmette-Guerin Bacillus with pneumonia and possibly hepatitis. These complications are rare and could be induced by both immuno-allergic reaction and bacteremia. There is no specific guideline to treat this condition, but many clinicians depicting similar cases seem to agree on prolonged anti-tuberculous antibiotics with associated corticosteroid therapy. Following this therapy, the prognosis is generally favorable depending upon the fact that diagnosis has correctly been made. Our case highlights the fact that correct diagnosis has to be made especially in the presence of sepsis without a clear septic source.
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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.
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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
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15
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BCGites après immunothérapie pour cancer de vessie, une pathologie hétérogène: physiopathologie, description clinique, prise en charge diagnostique et thérapeutique. Rev Mal Respir 2018; 35:416-429. [DOI: 10.1016/j.rmr.2017.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022]
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16
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Miyazaki J, Onozawa M, Takaoka E, Yano I. Bacillus Calmette-Guérin strain differences as the basis for immunotherapies against bladder cancer. Int J Urol 2018; 25:405-413. [DOI: 10.1111/iju.13538] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/16/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Jun Miyazaki
- Department of Urology; School of Medicine; International University of Health and Welfare; Chiba Japan
| | - Mizuki Onozawa
- Department of Urology; School of Medicine; International University of Health and Welfare; Chiba Japan
| | - Eiichiro Takaoka
- Department of Urology; School of Medicine; International University of Health and Welfare; Chiba Japan
| | - Ikuya Yano
- Faculty of Medicine; Osaka City University Graduate School of Medicine; Osaka Japan
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Abstract
The urologist must prevent, identify and properly treat the complications of intravesical chemotherapy and immunotherapy. Both local and systemic toxicity of adjuvant intravesical therapy is herein analyzed. Topical toxicity is mainly due to the inflammation induced by the contact between the instilled agent and the bladder mucosa. Material and Methods The factors predisposing to topical toxicity must be identified and removed before starting the treatment. The choice of the agent, its dose, concentration and dosage must be tailored, whenever possible, to the presence of the above mentioned factors. Mitomycin and BCG can rarely provoke chronic cystitis, severely compromising bladder function. Results The most dangerous complication of early intravesical chemotherapy is the instillation in presence of an unrecognized bladder perforation. Flu-like syndrome, fever, chills, arthralgia are reported in almost 20% of patients receiving BCG. If fever persists for more than 48 hours or exceeds 38.5 °C, isoniazid must be administered and BCG stopped until complete remission. BCG sepsis is a rare but severe complication that must be promptly recognized and treated. If not, a life-threatening multi-organ failure syndrome can arise. Isoniazid and rifampicin, adding ethambutol when required, must be administered for a prolonged period until complete remission. Conclusions Granulomatous lesions represent the main other rare systemic complications of BCG therapy. Systemic toxicity of intravesical chemotherapy is rare, due to the high molecular weight of the drugs, limiting systemic absorption.
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Affiliation(s)
- V. Serretta
- Dipartimento di Medicina Interna Malattie Cardiovascolari e Nefrourologiche, Sezione di Urologia, Università degli Studi di Palermo
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18
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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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19
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Liaw F, Tan YY, Hendry D. Systemic BCG-osis following intravesical BCG instillation for bladder carcinoma. Clin Case Rep 2017; 5:1569-1572. [PMID: 29026546 PMCID: PMC5628231 DOI: 10.1002/ccr3.1129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/22/2017] [Accepted: 07/08/2017] [Indexed: 11/06/2022] Open
Abstract
Intravesical instillation of Bacillus Calmette-Guérin (BCG) has been shown to be an effective form of immunotherapy for bladder cancer. This case report describes a patient who develops systemic BCG-osis following intravesical BCG instillation and demonstrates the importance of being aware of more severe complications associated with BCG immunotherapy.
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Affiliation(s)
- Frank Liaw
- Department of Urology Queen Elizabeth University Hospital Glasgow G51 4TF UK
| | - Yan Yu Tan
- Department of Gastroenterology Monklands Hospital Airdrie ML6 0JS UK
| | - David Hendry
- Department of Urology Queen Elizabeth University Hospital Glasgow G51 4TF UK
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20
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Agrawal A, Sahni S, Vulisha AK, Gumpeni R, Shah R, Talwar A. Pulmonary manifestations of urothelial carcinoma of the bladder. Respir Med 2017; 128:65-69. [PMID: 28610671 DOI: 10.1016/j.rmed.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/12/2017] [Accepted: 05/13/2017] [Indexed: 01/30/2023]
Abstract
Urothelial carcinoma (Transitional cell carcinoma) of the bladder is the pre-dominant histological type of bladder cancer in the United States and Europe. Patients with bladder cancer usually present with painless hematuria. The diagnosis is often delayed, as the symptoms are similar to various other benign conditions such as urinary tract infection, prostatitis or renal calculi. In some patients, the metastatic lesions will cause the initial presenting symptoms. We conducted a MedLine/PubMED search identifying all relevant articles with "pulmonary manifestations", "urothelial bladder cancer", "manifestations of bladder cancer" or a combination of these terms in the title. The pulmonary manifestations of urothelial carcinoma of the bladder include metastatic disease including cavitary lesions, endobronchial, pleural, or lymph node metastasis pleural effusion and chylothorax. Pulmonary embolism and tumor embolism is another manifestation of this cancer. Intravesical Bacillus Calmette-Gurin therapy for bladder cancer has been associated with a range of adverse effects including the systemic spread of Bacilli Calmette-Guérin immunotherapy affecting the lungs. Other drugs used to treat bladder cancer can be associated with drug-related pneumonitis. Other rare manifestations include a sarcoid like reaction and systemic granulomatous disease to Bacilli Calmette-Guérin therapy. In this review we discuss the various pulmonary manifestations of urothelial carcinoma of the bladder. A high index of suspicion with these presentations can lead to an early diagnosis and assist in instituting an appropriate intervention.
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Affiliation(s)
- Abhinav Agrawal
- Monmouth Medical Center, Department of Medicine, 300 Second Avenue Long Branch, NJ 07740, United States; Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States
| | - Sonu Sahni
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States; Touro College of Osteopathic Medicine, Department of Primary Care, New York, NY 10027, United States
| | - Abhinav K Vulisha
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States
| | - Rammohan Gumpeni
- New York Presbyterian Hospital Queens, Department of Pulmonary Critical Care Medicine, 56-45 Main Street Flushing, NY 11355, United States
| | - Rakesh Shah
- Northwell Health, Department of Radiology, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States
| | - Arunabh Talwar
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States.
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Roca Noval A, Cisneros C, García-Pérez FJ, Domingo D. Pleural effusion after intravesical administration of bacillus Calmette-Guérin. Arch Bronconeumol 2017; 53:694-695. [PMID: 28476221 DOI: 10.1016/j.arbres.2017.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Ana Roca Noval
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, España.
| | - Carolina Cisneros
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, España
| | | | - Diego Domingo
- Servicio de Microbiología, Hospital Universitario La Princesa, Madrid, España
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22
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Torres-Blanco Á, Gómez-Palonés F, Edo-Fleta G. Arteriocutaneous Fistula Associated with Bilateral Femoral Pseudoaneurysms Caused by Bacillus Calmette–Guérin. Apropos of a Case and Review of Literature. Ann Vasc Surg 2017; 39:291.e1-291.e6. [DOI: 10.1016/j.avsg.2016.07.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/28/2016] [Accepted: 07/16/2016] [Indexed: 10/20/2022]
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23
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Kaburaki K, Sugino K, Sekiya M, Takai Y, Shibuya K, Homma S. Miliary Tuberculosis that Developed after Intravesical Bacillus Calmette-Guerin Therapy. Intern Med 2017. [PMID: 28626185 PMCID: PMC5505915 DOI: 10.2169/internalmedicine.56.8055] [Citation(s) in RCA: 9] [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] [Indexed: 11/06/2022] Open
Abstract
As a treatment for superficial transitional cell carcinoma, Bacillus Calmette-Guerin (BCG) intravesical instillation can rarely cause unpredictable systemic side effects. We describe a patient admitted due to continuous pyrexia and general fatigue. He was previously treated with intravesical BCG. Laboratory data indicated a hepatic disorder, and chest computed tomography revealed extensive bilateral miliary nodules. Transbronchial lung biopsy specimens showed several small noncaseating granulomas. The diagnosis was unsolved on the basis of acid fast staining, polymerase chain reaction and microbiological cultures, so we considered the possibility of BCG side effect-induced granuloma. Two months after treatment with antituberculous agents and corticosteroids, his clinical symptoms were improved.
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Affiliation(s)
- Kyohei Kaburaki
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
| | - Keishi Sugino
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
| | - Muneyuki Sekiya
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
| | - Yujiro Takai
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
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24
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Madentzoglou MS, Nathena D, Sinatkas V, Michalodimitrakis M, Kranioti EF. Lethal BCG-osis, in the context of superficial urothelial bladder carcinoma, diagnosed in autopsy. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2015.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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25
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Disseminated Bacille Calmette-Guérin disease in immunocompetent adult patients. Braz J Infect Dis 2016; 20:408-9. [PMID: 27266591 PMCID: PMC9427595 DOI: 10.1016/j.bjid.2016.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/24/2016] [Indexed: 11/21/2022] Open
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26
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González-Del Vecchio M, Ruíz-Serrano MJ, Gijón P, Sánchez-Somolinos M, de Egea V, García de Viedma D, Sánchez Fresneda MN, Bouza E. Differences between a probable and proven BCG infection following intravesical instillations: 16 years experience in a tertiary care hospital. Diagn Microbiol Infect Dis 2016; 85:338-343. [PMID: 27157988 DOI: 10.1016/j.diagmicrobio.2016.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intravesical instillation of Bacillus Calmette-Guérin (BCG) is an efficient immunotherapy for superficial bladder cancer. BCG infection represents a major yet uncommon adverse event that occurs in 5-10% of the patients treated with BCG instillations, though the pathogenesis of this entity is not clear. METHODS We report two cases of patients presented at our institution with BCG infection after instillation: one with microbiological BCG isolate and another without, and review all the medical records of patients instilled with BCG in our institution from 1996 until 2012, comparing patients with probable and proven BCG infection. RESULTS During the study period, a total of 786 patients received BCG intravesical instillations. Of them, 31 (4%) patients had to suspend treatment because of adverse events and, specifically, 11 (1.3%) patients had to interrupt treatment because of suspected BCG infection. The incidence of BCG infection during our study period was 0.87 episodes per 1,000 instilled patients/year and 140 cases per 10,000 instilled patients. Of the 11 patients with suspected BCG infection, 7 (64%) had a probable BCG infection, while 4 (36%) patients had a proven BCG infection. All patients with a proven infection had a previous underlying condition, compared to a high proportion of patients with probable infection (57%) that did not present with underlying diseases. Common findings between both groups of patients were abnormal imaging studies and laboratory tests. Regarding treatment, 8 (73%) of the 11 patients with BCG infection received at least two first line drugs active against M. bovis (isoniazid, rifampicin or ethambutol), four patients (36%) received steroids as part of the treatment and curation was obtained in 10 (91%) patients, while 1 patient with a proven infection had a death related to BCG infection. CONCLUSIONS We can conclude that BCG infection after intravesical instillations has a low incidence in our institution. Patients with previous underlying conditions seem to have more proven infections. A high proportion of patients do not yield positive microbiological tests; in those cases the diagnosis relies in clinical, radiological and laboratory findings. Treatment for BCG infection should include at least two active drugs against M. bovis and coadjuvant steroid treatment for systemic BCG infections.
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Affiliation(s)
- Marcela González-Del Vecchio
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - María Jesús Ruíz-Serrano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Paloma Gijón
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Mar Sánchez-Somolinos
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Viviana de Egea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Darío García de Viedma
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | | | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
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27
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Intravesical BCG therapy as cause of miliary pulmonary tuberculosis. Urologia 2015; 83:49-53. [PMID: 26616461 DOI: 10.5301/uro.5000130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/20/2022]
Abstract
Immunotherapy with intravesical bacillus Calmette-Guérin (BCG) is considered the most effective adjuvant to endoscopic resection of bladder urothelial carcinoma in the therapeutic management of non-muscle invasive (NMIBC) at intermediate and high risk of recurrence and progression (pTa - pT1 and high-grade carcinoma in situ, CIS). Despite its proven efficacy, this type of treatment can determine local and systemic side effects of moderate or severe gravity, with the histological diagnosis of epithelioid granulomas in different organs, even in the absence of microbiological positivity of BCG. The immunotherapy with BCG is usually well tolerated and the virulence of the attenuated BCG is very low in immuno-competent patients, although only 16% of patients are able to receive all the instillations of the maintenance period (3 years) of treatment provided by the protocols, precisely because of side effects. Minor side effects usually resolve within a few hours or days. They develop in 3-5% of patients and usually consist of local infectious complications. Manifestations of BCG dissemination, such as vascular and ocular complications, are much less common, while BCG-disseminated infections, with granulomatous pneumonia or hepatitis present, are quite rare, representing 0.5-2% of the complications recorded. We present the clinical case of granulomatous lung and possibly liver infection caused by BCG in a patient aged 56 years being treated for several weeks with intravesical BCG for NIMBC pT1 high grade associated with CIS.
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28
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Linfadenitis granulomatosa mediastínica tras tratamiento con bacilo Calmette-Guérin intravesical que simula metástasis distante de carcinoma vesical primario. Arch Bronconeumol 2015; 51:526-7. [DOI: 10.1016/j.arbres.2014.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 11/18/2022]
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29
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Gandhi NM, Bertrand LA, Lamm DL, O'Donnell MA. Intravesical immunotherapy. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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30
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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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Larsen BT, Smith ML, Grys TE, Vikram HR, Colby TV. Histopathology of Disseminated Mycobacterium bovis Infection Complicating Intravesical BCG Immunotherapy for Urothelial Carcinoma. Int J Surg Pathol 2015; 23:189-95. [PMID: 25614462 DOI: 10.1177/1066896914567332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intravesical instillation of Bacillus Calmette-Guérin (BCG) is a mainstay of adjunctive therapy for superficial bladder cancer. Disseminated BCG infection ("BCG-osis") after this therapy is rare and potentially life-threatening; only isolated case reports detail the histopathologic findings thereof, few of which had a diagnosis confirmed by molecular testing. We report 3 additional cases of BCG-osis complicating BCG therapy, all confirmed by cultures and molecular assays, including the first cases of wedge biopsy-confirmed BCG pneumonia and BCG olecranon bursitis. When suggested by a relevant clinical history, recognition of randomly distributed granulomas in any organ should prompt consideration of BCG-osis and liberal performance of AFB stains, aided by targeted molecular assays. Physicians should maintain a high index of suspicion when miliary infiltrates arise after intravesical BCG instillation, and close multidisciplinary communication is essential. Pathologist awareness of this rare cause of granulomatous inflammation aids recognition of BCG-osis and facilitates prompt initiation of antimycobacterial therapy.
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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: 181] [Impact Index Per Article: 18.1] [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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Choi CHR, Lee SO, Smith G. Subclinical miliary Mycobacterium bovis following BCG immunotherapy for transitional cell carcinoma of the bladder. BMJ Case Rep 2014; 2014:bcr-2013-201202. [PMID: 24811557 DOI: 10.1136/bcr-2013-201202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present an unusual case of a 51-year-old man who developed relatively mild non-specific symptoms following intravesical BCG instillation for superficial transitional cell carcinoma of the bladder, with radiological investigations demonstrating typical features of miliary tuberculosis (TB). Transbronchial biopsy showed small foci of poorly formed granuloma suggestive of Mycobacterium infection. The patient's respiratory symptoms only became apparent 7 days after discharge having had 4 weeks of unremarkable inpatient stay where he remained clinically well. Prompt anti-TB treatment resulted in a remarkable improvement in his symptoms and radiological appearance, supporting the diagnosis of disseminated Mycobacterium bovis infection. This case highlights the importance of recognising miliary M bovis as a potential complication in patients receiving BCG immunotherapy, and that the disease course can be subclinical with delayed onset of symptoms.
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Delimpoura V, Samitas K, Vamvakaris I, Zervas E, Gaga M. Concurrent granulomatous hepatitis, pneumonitis and sepsis as a complication of intravesical BCG immunotherapy. BMJ Case Rep 2013; 2013:bcr-2013-200624. [PMID: 24114600 DOI: 10.1136/bcr-2013-200624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intravesical administration of BCG is a relatively simple procedure used successfully in the treatment of superficial transitional cell carcinoma of the urinary bladder. It is usually well tolerated with few major side effects. The authors report the case of an 80-year-old man who presented with sepsis, jaundice, hepatic and pulmonary failure 10 days after his last BCG instillation therapy, that was attributed to concurrent granulomatous hepatitis and pneumonitis due to Mycobacterium bovis dissemination. In rare instances severe life-threatening complications occur in relation with BCG instillation immunotherapy that may involve multiple organs and have different presentations and require a high index of suspicion and clinical awareness in a wide range of medical specialties.
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Affiliation(s)
- Vasiliki Delimpoura
- 7th Respiratory Department and Asthma Centre, Athens Chest Hospital, Athens, Greece
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35
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Airy M, Raghavan R, Truong LD, Eknoyan G. Tubulointerstitial nephritis and cancer chemotherapy: update on a neglected clinical entity. Nephrol Dial Transplant 2013; 28:2502-9. [DOI: 10.1093/ndt/gft241] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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García Baldoví M, Pérez-Crespo M, Onrubia J, Moragón M. Granulomatous Balanitis After Intravesical Bacille Calmette-Guérin Instillation. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.06.027] [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] Open
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Samadian S, Phillips FM, Deeab D. Mycobacterium bovis vertebral osteomyelitis and discitis with adjacent mycotic abdominal aortic aneurysm caused by intravesical BCG therapy: a case report in an elderly gentleman. Age Ageing 2013; 42:129-31. [PMID: 23151379 DOI: 10.1093/ageing/afs164] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The bacille Calmette-Guérin, a live attenuated form of Mycobacterium bovis, has been used as anti-cancer immunotherapy for superficial bladder cancer since 1976 [ 1]. It is now the mainstay of therapy for this condition, which is partly attributable to the low complication rate; indeed 95% have no significant side effects [ 2]. However, proven disseminated M. bovis infection has been documented, as is the case with our elderly patient.
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Affiliation(s)
- Samad Samadian
- Care of the Elderly, St Helier Hospital, Wrythe Lane Carshalton SM5 1AA, UK.
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38
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García Baldoví M, Pérez-Crespo M, Onrubia J, Moragón M. Granulomatous balanitis after intravesical Bacille Calmette-Guérin instillation. ACTAS DERMO-SIFILIOGRAFICAS 2012. [PMID: 23177394 DOI: 10.1016/j.ad.2012.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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39
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Pittman M, Sakai L, Craig R, Joehl R, Milner R. Primary aortoenteric fistula following disseminated bacillus Calmette-Guérin infection: a case report. Vascular 2012; 20:221-4. [PMID: 22871545 DOI: 10.1258/vasc.2011.cr0315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this paper is to illustrate a rare case of primary aortoenteric fistula in the presence of disseminated infection and review the critical decision-making process. A clinical case was reviewed for its initial presentation, planning of treatment strategy and outcome. A secondary literature search for discussion on current accepted recommendations for primary aortoenteric fistula was then completed. Aortoenteric fistulas are rare pathologies with highly morbid potential. Their diagnosis requires a high index of suspicion and prompt intervention is critical to patient survival. In conclusion, aortoenteric fistula most commonly arises from large atherosclerotic aneurysms but can be caused by systemic infection. In the case of the latter, extra-anatomic repair appears to be the treatment of choice.
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Affiliation(s)
- M Pittman
- Department of Vascular Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
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Colmenero JD, Sanjuan-Jimenez R, Ramos B, Morata P. Miliary pulmonary tuberculosis following intravesical BCG therapy: case report and literature review. Diagn Microbiol Infect Dis 2012; 74:70-2. [PMID: 22749242 DOI: 10.1016/j.diagmicrobio.2012.05.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 05/16/2012] [Accepted: 05/17/2012] [Indexed: 11/18/2022]
Abstract
Miliary tuberculosis after intravesical Calmette-Guerin bacilli (BCG) therapy is rare. To date, only 23 cases have been reported. We describe the case of a patient on hemodialysis, review the literature, and call attention to the potential hazard of intravesical BCG therapy in patients on renal replacement therapy and the value of polymerase chain reaction-based methods for early diagnosis of this serious complication.
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Affiliation(s)
- Juan D Colmenero
- Infectious Diseases Service, Carlos Haya University Hospital, Malaga, 29010, Spain.
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Garmilla-Ezquerra P, Martínez-De Las Cuevas G, Hernández-Hernández JL. [Granulomatous hepatitis and sepsis secondary to intravesical instillation of bacillus Calmette-Guérin]. Enferm Infecc Microbiol Clin 2012; 30:656-7. [PMID: 22683174 DOI: 10.1016/j.eimc.2012.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/16/2012] [Accepted: 04/19/2012] [Indexed: 10/27/2022]
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Lestre SIA, Gameiro CD, João A, Lopes MJP. Granulomas do pênis: uma complicação rara da terapia intravesical com Bacilo Calmette-Guérin. An Bras Dermatol 2011; 86:759-62. [DOI: 10.1590/s0365-05962011000400021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 06/21/2010] [Indexed: 11/22/2022] Open
Abstract
A imunoterapia com o Bacilo Calmette-Guérin é amplamente usada no tratamento e profilaxia da neoplasia urotelial superficial. As complicações associadas ao tratamento são comuns. Os autores relatam um caso de inflamação granulomatosa do pênis, associada à terapia intravesical com Bacilo Calmette-Guérin, com múltiplos nódulos eritematosos indolores localizados na glande. É também efetuada uma revisão da literatura. A balanopostite granulomatosa é uma complicação rara associada à imunoterapia com Bacilo Calmette-Guérin, com uma apresentação clinicamente heterogênea que pode dificultar o diagnóstico. O seu reconhecimento clínico é essencial para o início precoce de tuberculostáticos e interrupção de Bacilo Calmette-Guérin
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Fradet V, Gaudreau C, Perrotte P, Côté J, Paquin JM. Management of hepatic granulomatous tuberculosis complicating intravesical BCG for superficial bladder cancer. Can Urol Assoc J 2011; 1:269-72. [PMID: 18542802 DOI: 10.5489/cuaj.83] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intravesical bacille Calmette-Guérin (BCG) therapy is the most effective treatment for high-risk superficial bladder cancer. Severe systemic complications are rare, but may occur in approximately 1% of cases. We report a severe complication of intravesical BCG: a disseminated Mycobacterium bovis infection with biopsy-proven granulomatous hepatitis in a patient with bladder cancer. We also elaborate on the different management alternatives.
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Affiliation(s)
- Vincent Fradet
- Departement of Surgery (urology), the Department of Microbiology and the Department of Pathology, Centre Hospitalier de l'Université de Montréal-Hôpital St-Luc, Montréal, Que
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Nazir T, Talab SK, Kadir S. Systemic granulomatous disease and syndrome of inappropriate antidiuretic hormone. Br J Hosp Med (Lond) 2010; 71:472-3. [PMID: 20852492 DOI: 10.12968/hmed.2010.71.8.77673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- T Nazir
- Geriatrics and General (Internal) Medicine, Victoria Hospital, Blackpool
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46
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Cobas Paz A, García Tejedor JL, González Piñeiro A, Fernández-Villar A. [Miliary tuberculosis due to BCG in an asymptomatic patient: initial onset or a condition not yet described?]. Arch Bronconeumol 2010; 46:394-5. [PMID: 20171773 DOI: 10.1016/j.arbres.2010.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Accepted: 01/06/2010] [Indexed: 11/16/2022]
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47
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The role of neutrophils and TNF-related apoptosis-inducing ligand (TRAIL) in bacillus Calmette–Guérin (BCG) immunotherapy for urothelial carcinoma of the bladder. Cancer Metastasis Rev 2009; 28:345-53. [DOI: 10.1007/s10555-009-9195-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Blanchet E, Goupil F, Lassalle V, Prost A, Alami O, Lebas FX. BCGite systémique : intérêt du TEP ? Rev Mal Respir 2009. [DOI: 10.1016/s0761-8425(09)74680-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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49
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Beltrami P, Ruggera L, Cazzoletti L, Schiavone D, Zattoni F. Are prostate biopsies mandatory in patients with prostate-specific antigen increase during intravesical immuno- or chemotherapy for superficial bladder cancer? Prostate 2008; 68:1241-7. [PMID: 18484098 DOI: 10.1002/pros.20790] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Aim of this study was to evaluate if there was a significant association between intravesical immuno- or chemotherapy and the increase of PSA serum level. It could be important to avoid useless prostate biopsies. METHODS PSA values were determined in 106 male patients who had undergone intravesical immuno- (77 cases) or chemotherapy (29 cases) from 2001 to 2005. Blood samples were obtained before and after the induction course of instillation therapy and at 3, 6, and 12 months during the maintenance course. RESULTS 41.6% of patients at the end of the BCG induction course and 45.5% at 3 months from the beginning of the immunotherapy showed a clinically and statistically significant increase of PSA that returned to the baseline levels within 12 months. Prostate biopsies, performed in 10 patients during BCG therapy, showed inflammatory pictures in 9 cases and a prostate cancer in 1 patient with persistently elevated PSA at 12 months. In 1 case a prostate cancer was histologically found following radical cystectomy for disease progression. A statistically but not clinically significant difference of PSA level was registered in patients treated with chemotherapy. CONCLUSIONS Our results confirm that a statistically and clinically significant PSA increase is registered during immunotherapy but not during chemotherapy. PSA elevation in patients treated with intravesical BCG is self-limited and prostate biopsies are not mandatory in these patients and could be delayed at 12 months, while monitoring PSA. On the other side, prostate biopsies are mandatory in patients with PSA abnormal elevation during chemotherapy.
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Affiliation(s)
- Paolo Beltrami
- Department and Clinic of Urology, University of Verona, Italy
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50
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Safdar N, Abad CL, Kaul DR, Jarrard D, Saint S. Clinical problem-solving. An unintended consequence--a 79-year-old man with a 5-month history of fatigue and 20-lb (9-kg) weight loss presented to his local physician. N Engl J Med 2008; 358:1496-501. [PMID: 18385502 DOI: 10.1056/nejmcps0706711] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Nasia Safdar
- Department of Medicine, University of Wisconsin School of Medicine, Madison, WI 53792, USA.
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