Corticosteroid-Associated Fatal Mycobacterial Sepsis Occurring 3 Years after Instillation of Intravesical Bacillus Calmette-Guerin

Multiple mycotic aneurysms due to Mycobacterium bovis after intravesical bacillus Calmette-Guérin therapy

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Mean age at diagnosis was 72 years (range, 58-80 years), and aneurysms were diagnosed a mean of 23 months (range, 4-69 months) after BCG therapy. Episodes of fever or fatigue during or immediately after BCG instillations were reported by 11 patients (52%), but were absent in our patient.…”

“…Similar to our patient, 11 patients (52%) presented with rupture, with histologic finding of arterial wall necrosis in most. Several patients were immunocompromised at the time of diagnosis because of corticosteroid therapy 8,9,11,15 or chemotherapy. 6 1. direct intimal colonization during an hematogenous dissemination, especially in the setting of an altered arterial wall by atherosclerosis; 2. metastatic implantation of the bacteria through adventitial vasa-vasorum, or 3. local vascular extension of an infected site such as contiguous lymphadenitis.…”

“…It was positive in all but one reported case. 8 Other diagnostic tests with lower specificity were also reported and include direct acid-fast bacilli detection, [6][7][8][9][10][11][12]14,15,17,18,[20][21][22][23][24] evidence of typical caseating granulomatous lesions, 6,7,9,13,[17][18][19][20][21][22][23] and PCR 10,18 from various tissue samples.…”

Isolated Renal Tuberculosis following Intravesical Bacillus Calmette-Guérin Therapy for Bladder Cancer

“…Although it has been suggested that nontraumatic intravesical instillation of BCG is not accompanied by systemic mycobacterial spread [5], severe systemic infections have been described several months or years after the termination of the BCG instillation [6,7]. Bohle et al [6] reported a case of pulmonary persistence of BCG even after cystectomy.…”

“…It has been pointed out that BCG should not be given to immunocompromised patients [1]. It has also been reported that corticosteroid treatment and a stressful surgical procedure might cause fulminant BCG sepsis [7]. If there is a risk of a dormant subclinical systemic tuberculosis infection, it might be better to treat the patients with an antituberculous drug therapy.…”