Bilateral Panuveitis following Intravesical BCG Immunotherapy for Bladder Carcinoma

Uppal, Gurmit; Shah, Amita; Tossounis, Charalambos M.; Tappin, Michael J.

doi:10.3109/09273948.2010.486099

Cited by 25 publications

(14 citation statements)

References 6 publications

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“…Ocular toxicity like bilateral uveitis,[16] endophthalmitis,[7] choroiditis,[8] chorioretinitis,[9] granulomatous uveitis, endogenous endophthalmitis with B\L infiltrative retinitis, and vitritis[5] have been reported.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral symmetrical corneal melting following intravesical Bacille Calmette-Guerin therapy for bladder carcinoma

et al. 2012

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A 63-year-old man with unremarkable previous ocular history presented with bilateral symmetrical corneal ulceration along with mucopurulent conjunctivitis and dry eye 10 days after the fourth dose of intravesical Bacille Calmette-Guerin (BCG) instillation for treatment of bladder carcinoma. Slit lamp examination revealed thinning of the cornea at the base of the ulcer in both eyes. Conjunctival swab and scraping from ulcer sent for Gram and acid fast bacilli stain and culture were negative. On the basis of history, clinical examination, and laboratory investigations, we diagnosed it as bilateral immune mediated sterile corneal ulceration along with mucopurulent conjunctivitis and dry eye. He was treated with topical antibiotics, cycloplegics, cyclosporine, lubricant gel, and bandage contact lens. There was progressive stromal melting, descemetocele formation, and perforation in the inferior part of cornea in both the eyes. He was treated with pulse steroid and paramedian tarsorraphy in both eyes. The patient was subsequently lost to follow-up. We report this case to highlight this rare complication of BCG therapy, in order to improve their management protocol in patients with similar clinical profile. We could not find a similar case after thorough PubMed search.

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Section: Discussionmentioning

confidence: 99%

“…Ocular complications such as keratitis, uveitis,[1] conjunctivitis,[4] autoimmune retinopathy,[5] panuveitis,[6] endophthalmitis,[7] choroiditis,[8] and chorioretinitis[9] have been documented.…”

Section: Introductionmentioning

confidence: 99%

Bilateral symmetrical corneal melting following intravesical Bacille Calmette-Guerin therapy for bladder carcinoma

et al. 2012

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“…International Immunopharmacology j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / i n t i m p some research has reported [15,16] that some patients developed complications after intravesical instillation of BCG: high temperature followed by hematuria or granulomatous prostatitis, epidydimoorchitis, urethral obstruction and so on. Muramyl dipeptide (N-acetyl-muramyl-L-Ala-D-isoGln, MDP) is the minimal essential structure of the mycobacterial cell wall in Freund's complete adjuvant.…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 97%

Preparation and identification of a novel immunomodulator composed of muramyl dipeptide and anti-CD10 monoclonal antibody for treatment of minimal residual disease in acute leukemia children

Wang

Sun

Zhao

et al. 2011

International Immunopharmacology

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“…However, BCG is still widely and successfully used as local treatment for bladder carcinomas. Several cases of uveitis as side effects of BCG instillation are reported in the literature (Uppal et al, 2010). The group of Wildner described a patient who presented with bilateral granulomatous iritis 2 weeks after she developed cystitis from BCG-instillation to treat her bladder carcinoma.…”

Section: Interplay Between Innate and Adaptive Immunity In The Devmentioning

confidence: 99%

Interplay between innate and adaptive immunity in the development of non-infectious uveitis

Willermain

Rosenbaum

Bodaghi

et al. 2012

Progress in Retinal and Eye Research

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In vertebrates, the innate and adaptive immune systems have evolved seamlessly to protect the host by rapidly responding to danger signals, eliminating pathogens and creating immunological memory as well as immunological tolerance to self. The innate immune system harnesses receptors that recognize conserved pathogen patterns and alongside the more specific recognition systems and memory of adaptive immunity, their interplay is evidenced by respective roles during generation and regulation of immune responses. The hallmark of adaptive immunity which requires engagement of innate immunity is an ability to discriminate between self and non-self (and eventually between pathogen and symbiont) as well as peripheral control mechanisms maintaining immunological health and appropriate responses. Loss of control mechanisms and/or regulation of either the adaptive or the innate immune system lead to autoimmunity and autoinflammation respectively. Although autoimmune pathways have been largely studied to date in the context of development of non-infectious intraocular inflammation, the recruitment and activation of innate immunity is required for full expression of the varied phenotypes of non-infectious uveitis. Since autoimmunity and autoinflammation implicate different molecular pathways, even though some convergence occurs, increasing our understanding of their respective roles in the development of uveitis will highlight treatment targets and influence our understanding of immune mechanisms operative in other retinal diseases. Herein, we extrapolate from the basic mechanisms of activation and control of innate and adaptive immunity to how autoinflammatory and autoimmune pathways contribute to disease development in non-infectious uveitis patients.

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Bilateral Panuveitis following Intravesical BCG Immunotherapy for Bladder Carcinoma

Abstract: Ocular inflammations following BCG therapy for bladder cancer are rare, and little is known about the management of such cases. This is the first report of bilateral panuveitis with optic nerve edema following such treatment.

Cited by 25 publications

References 6 publications

Bilateral symmetrical corneal melting following intravesical Bacille Calmette-Guerin therapy for bladder carcinoma

Bilateral symmetrical corneal melting following intravesical Bacille Calmette-Guerin therapy for bladder carcinoma

Preparation and identification of a novel immunomodulator composed of muramyl dipeptide and anti-CD10 monoclonal antibody for treatment of minimal residual disease in acute leukemia children

Interplay between innate and adaptive immunity in the development of non-infectious uveitis

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