A Case of Epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma in a patient with latent tuberculosis infection

Abstract

BackgroundIntravesical instillation of bacille Calmette-Guérin (BCG) has been established as efficient therapy for superficial bladder carcinoma. Overall, intravesical BCG is well tolerated and results in complications of less than 5 %. However, adverse effects such as granulomatous prostatitis, pneumonitis, hepatitis, sepsis, and hypersensitivity reactions may occur. The reported rate for tuberculous orchitis after BCG intravesical therapy is 0.4 %.FindingsWe report a case of monolateral tuberculous orchitis occurring one month after the second course of intravescical instillation of bacille Calmette-Guérin in a patient with proven superficial bladder carcinoma and latent tuberculosis infection.ConclusionsIn our opinion intravesical instillation of BCG should be considered on an individual patient basis, with full patient disclosure of the potentially significant risks. A screening with an intradermal Mantoux before starting the first cycle of BCG instillation should be recommended and isoniazid would be indicated as the treatment for latent tuberculosis infection.

Multiparametric ultrasound findings of tuberculous orchitis following bacillus Calmette-Guérin therapy

“…A search of the MEDLINE database using the EBSCO search engine yielded up to 15 previously reported cases of epididymo-orchitis as a complication of intravesical BCG therapy [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . The age range of the patients reported in these articles span between 54 and 83 years, which makes our patient the oldest reported case of BCG-related orchitis.…”

Impacto de la ley uruguaya de seguridad vial en la mortalidad por siniestros de tránsito

“…Se ha reportado que la presencia de síntomas irritativos vesicales (disuria, polaquiuria) es muy frecuente (90% de los casos) y se acompaña algunas veces de síntomas sistémicos leves (febrícula 24%, malestar general 18%, escalofríos 8%); por el contrario, las reacciones adversas mayores ocurren en menos del 5% de los pacientes (13) . Se han comunicado casos excepcionales de infecciones diseminadas por M. bovis en pacientes con cáncer de vejiga luego de la inmunoterapia intravesical con BCG (13)(14)(15)(16)(17)(18)(19)(20) y se estimó una mortalidad 1/12.500 pacientes tratados (13) . El estudio EORTC, con más de 1.300 pacientes incluidos, puso en evidencia que en el 63% de los que iniciaron tratamiento con BCG intravesical se detectaron efectos secundarios locales y 31% presentó algún tipo de efecto secundario sistémico, a partir de un corto período frecuente de fiebre y malestar general (21,22) .…”

BCG orchitis

“…Intravesical BCG is FDA approved and part of the American Urological Association and National Cancer Comprehensive Network's guidelines for the treatment of intermediate and high-risk non-muscle invasive bladder cancer with well-established decreases in recurrence and progression. The attenuated virus activates the Th-1 immune system leading to T-cell attack of abnormal urothelium with a direct inhibitory effect on tumor cell invasion through increases interferon-γ and IL-2 which up-regulate natural killer cells 1, 2, 3, 4, 5…”

“…Infectious side effects is described as high fevers or shaking chills consistent with systemic absorption and is attributed to a type-IV delayed hypersensitivity reaction. BCG sepsis has a mortality rate of one death for every 12,500 patients treated with intravesical BCG 1, 2, 3, 4, 5…”

“…This may be an underreported side effect due to its frequently asymptomatic course. Its more infrequent counter-part is granulomatous orchitis with a reported rate of 0.4% 1, 2, 3, 4, 5…”