Chorioretinitis Induced by Intravesical Bacillus Calmette-Guérin (BCG) Instillations for Urinary Bladder Carcinoma

Abstract

BCG chorioretinitis is a rare complication that can be seen after intravesical BCG therapy. BCG is a live attenuated strain of Mycobacterium bovis. Two mechanisms can be proposed as the origin of ocular inflammation: a local immune response or a direct choroidal mycobacterial infection.

Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy: Case report

“…In this study, a 57 year-old patient developed bilateral ocular lesions that resembled those observed in our patient, following a 6-month course with intravesical BCG with the Connaught strain. Similar to our patient, his choroidal lesions did not progress after therapy with rifampin, isoniazid, and ethambutol [6]. …”

“…Despite the negative acid fast stain, a high level of suspicion for mycobacterial infection resulted in further testing and the eventual establishment of multiorgan involvement with Mycobacterium bovis BCG. While hepatic, bone marrow, and pulmonary involvement have been extensively documented, the occurrence of mycobacterial choroiditis has only been reported in one prior case report [6]. In this study, a 57 year-old patient developed bilateral ocular lesions that resembled those observed in our patient, following a 6-month course with intravesical BCG with the Connaught strain.…”

“…No vitritis or retinal edema was present. A diagnosis of bilateral, multifocal choroiditis was made and attributed to a rare manifestation of intraocular BCG involvement [6]. …”

“…Disseminated BCG infections presenting as pneumonitis or granulomatous hepatitis, are rare: in the largest retrospective study reported to date, dissemination occurred in 0.7% of over 2,000 patients [4]. Ocular BCG manifestations include uveitis, endophthalmitis, and rarely choroiditis [5,6]. The mechanism of BCG-related choroiditis is unclear - it may be due to a hypersensitivity response or to direct choroidal seeding by the bacteria.…”

Tubercular Disease Caused by Bacillus of Calmette-Guérin as a Local Adjuvant Treatment of Relapsing Bladder Carcinoma

“…23 From a pathogenetic point of view, also, reliable animal models have demonstrated that the exposure to mycobacterial antigens (including those of M. bovis) may exacerbate the clinical expression of a pulmonary M. tuberculosis disease (and mycobacterial diseases as a whole) due to the demonstrated immune activation mechanisms, which increase the respiratory inflammation process via the secretion of large amounts of TNF-alpha and other proinflammatory cytokines, concurrently blunting most of the defense mechanism, and the containment of local pulmonary mycobacterial load. 24 After the first relevant survey conduced on over 2600 urologic cancer patients by Lamm et al, 21 single case reports have been published in the international literature regarding anecdotal episodes of respiratory involvement (BCG pneumonia), 22 granulomatous hepatitis, 25,26 renal involvement (granulomatous nephritis), 27 bone marrow invasion concurrent with liver disease, 28 local ocular involvement (corioretinitis), 29 and also vascular damage, mostly represented by aneurismatic lesions (of either native or prosthetic large vessels), 30,31 in 1 single episode associated with vertebral osteomyelitis, too. 31 Finally, secondary to local (i.e., in-…”