A rare case of multi-focal human TB after BCG instillation for non-muscle-invasive bladder cancer

Abstract

Objective: To describe a left epididymitis and para-aortical involvement caused by Mycobacterium tuberculosis hominis reactivation after bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer. Patient and methods: A Caucasian male, aged 76 years, exposed to bacillus Calmette-Guérin for a high-grade non-muscle-invasive bladder cancer in 2015, reported painful and progressive left scrotal swelling with purulent discharge from a cutaneous fistulous track that yielded, on liquid culture, a pan-susceptible Mycobacterium tuberculosis hominis strain. Moreover, after 6 months of anti-tuberculosis treatment, an abdominal peri-aortic mass, sized 4 cm, was found and a surgical biopsy showed necrotizing granulomas; however, although smear microscopy and Xpert MTB/Rif™ performed on fresh biopsy sample were positive, liquid cultures resulted negative, indicating treatment efficacy. Results: Numerous peculiar and multi-organ involvement due to BCGitis after intravesical immunotherapy have been previously described, including 17 scientific articles about epididymitis, however, no reports so far showed reactivation of Mycobacterium tuberculosis hominis after bacillus Calmette-Guérin treatment. Conclusion: Although BCGitis is more prevalent in patients undergoing bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer, tuberculosis by other species of Mycobacterium tuberculosis should be always ruled out by molecular and conventional microbiology in patients with a history of Mycobacterium tuberculosis hominis exposure.

Rapid Detection and Quantification of Mycobacterium tuberculosis DNA in Paraffinized Samples by Droplet Digital PCR: A Preliminary Study

“…Biopsies were subdivided in two subsamples by trained medical personnel. One fresh subsample was immediately tested for MTB diagnosis by culture methods, using both solid (Lowenstein–Jensen) and liquid (MGIT 960; Becton Dickinson Biosciences, Sparks, MD, United States) media [ European Centre for Disease Prevention and Control (ECDC), 2018 ; Riccardi et al, 2020 ]. Fresh subsamples were also analyzed for AFB microscopy and Xpert ® MTB/RIF (Cepheid, Sunnyvale, CA, United States) ( Tortoli et al, 2012 ).…”