BCG

Abstract

Aortic aneurysms and Mycobacterium bovis graft infection: 3 case reportsIn a case series, three men aged 61-79 year were described, who developed aortic aneurysms following treatment with BCG for non-muscle-invasive bladder cancer. Subsequently, they developed Mycobacterium bovis graft infection secondary to BCG therapy [dosages not stated].Case A: An approximately 61-year-old man developed aortic aneurysms following treatment with BCG for non-muscle-invasive bladder cancer (NMIBC). Subsequently, he developed Mycobacterium bovis graft infection. In November 2010, the man presented with persistent weakness, fever, night sweat and unspecific abdominal pain lasting for 2 weeks at 63 years of age. In 2008, he had been treated for NMIBC by transurethral resection and had received three cycles of intravesical BCG instillations. Subsequently, he had developed a ruptured infrarenal abdominal aortic aneurysm secondary to BCG. Therefore, surgery was performed and an aortobiiliac graft was implanted without antitubercular medication. Another 2 years later, in August 2012, he presented again to fever, elevated WBC and increased CRP. CT scan demonstrated the recurrence of a large mass in the retroperitoneum. He underwent CT-guided aspiration. A microscopic examination of specimens revealed necrotising granulomatous inflammation with multinucleated giant cells. Direct PCR tested positive for Mycobacterium tuberculosis complex. Growth of Mycobacterium bovis in solid and liquid culture confirmed the suspected diagnosis. Mycobacterium bovis graft infection was attributed to BCG treatment. Therefore, he was started on isoniazid, rifampicin and ethambutol the fluid collection was removed surgically. Intraoperatively, a partial affection of the left leg of the bifurcated graft by the necrotic mass was detected. After extensive debridement, vacuumassisted wound therapy was initiated. After 4 weeks of negative pressure wound therapy, the wound could be closed in secondary intention. CT scan demonstrated no signs of persistent graft infection or retroperitoneal abscess. Hence, he was discharged in good condition. The triple antitubercular treatment was continued for 6 months. Thereafter, he remained free of symptoms, and CT scan was unremarkable. Antitubercular therapy was subsequently terminated. After a follow-up of 84 months, he was in excellent condition and there is no CT-morphologic sign of recurrence of retroperitoneal abscess or inflammation of vascular graft.Case B: A man in his 70s developed aortic aneurysms following treatment with BCG for non-muscle-invasive bladder cancer. Subsequently, he developed Mycobacterium bovis infection secondary to BCG therapy at the age of 78 years. The man presented with acute abdominal pain and chronic back pain for 6 weeks in January 2018 at 78 years of age. CT scan demonstrated saccular aneurysmatic formation suspicious for a penetrating aortic ulcer (PAU) with contained rupture in the infrarenal aorta. Bone lesions in the vertebral bodies L2/L3 were suspicious for concomitant spondylodiscit...