Disseminated Bacillus Calmette-Guérin (BCG) infection with pulmonary and renal involvement: A rare complication of BCG immunotherapy. A case report and narrative review

Marques, Marta; Vázquez, Dolores; Sousa, Susana; Mesquita, Gonçalo; Duarte, Maria; Ferreira, Rosa

doi:10.1016/j.pulmoe.2019.10.001

Cited by 23 publications

(26 citation statements)

References 31 publications

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“…Miliary TB as a manifestation of pulmonary involvement of BCG infection is very rare, and only a very few cases have been reported thus far. 1,5,6,7 Although its pathogenesis remains incompletely understood, some authors consider pulmonary BCGitis to be a type of hypersensitivity reaction as serological tests and cultures are negative in approximately 60% of cases. However, some case reports support the theory of haematogenous spread from an active mycobacterial infection based on the isolation of mycobacteria or the detection of its genome by PCR, as in this case.…”

Section: Discussionmentioning

confidence: 99%

A unique case of miliary pulmonary tuberculosis induced by bacillus Calmette-Guérin intravesical instillation with COVID-19 superinfection

Brandi¹,

Bartalena²,

Mosconi³

et al. 2021

South African Journal of Radiology

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Intravesical instillation of Bacillus Calmette-Guérin (BCG) is used as an adjuvant treatment of bladder cancer. Systemic BCG infection occurs in less than 1% of cases, and pulmonary involvement is even rarer (0.3% – 0.7%), with a favourable prognosis. A 78-year-old male developed miliary tuberculosis (TB) secondary to intravesical BCG treatment and subsequent coronavirus disease 2019 (COVID-19) superinfection that led to patient death. High awareness amongst clinicians is needed to proceed with immediate appropriate therapy in these patients, especially during the COVID-19 pandemic

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Section: Discussionmentioning

confidence: 99%

A unique case of miliary pulmonary tuberculosis induced by bacillus Calmette-Guérin intravesical instillation with COVID-19 superinfection

Brandi¹,

Bartalena²,

Mosconi³

et al. 2021

South African Journal of Radiology

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Section: Introductionmentioning

confidence: 99%

“…Despite the efficacy of intravesical BCG therapy, most patients report local, mild, early complications after instillation, like cystitis (81%), macroscopic hematuria (15%), and urination frequency [ 9 – 13 ]. Although BCG therapy is usually well-tolerated, local and systemic complications can occur [ 9 , 10 , 13 ]. Local complications involve the genitourinary tract in the form of epididymitis and granulomatous prostatitis, while systemic ones include short-term fever in 5–30% of patients, as well as allergic reactions, reactive arthritis, drug-induced liver injury, granulomatous hepatitis, and nephritis, all with a prevalence of less than 1% [ 10 , 12 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Disseminated (or systemic) BCG infection (BCGitis) is the most severe adverse effect of intravesical BCG therapy. BCGitis has an incidence of 3% to 7% and presents with high-grade fever and/or various organ involvement with or without symptoms from the urinary tract, leading to severe sepsis and death if left untreated [ 9 , 10 , 16 – 19 ]. BCGitis should be suspected in any patient who develops moderate-to-severe genitourinary or systemic symptoms following ≥1 instillation of intravesical BCG when no alternative diagnosis can be established.…”

Section: Introductionmentioning

confidence: 99%

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Difficulties in Diagnosing and Treating Disseminated Bacillus Calmette-Guérin (BCG) Infection After Intravesical BCG Therapy in a Patient with Liver Cirrhosis: A Case Report

et al. 2021

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Patient: Male, 62-year-old Final Diagnosis: BCGitis Symptoms: Fever • general fatigue Medication: — Clinical Procedure: Bone marrow biopsy • liver biopsy Specialty: Infectious Diseases • General and Internal Medicine Objective: Rare coexistence of disease or pathology Background: Bladder cancer (BC) is the second most common cancer involving the urinary system. In non-muscle-invading BC, transurethral resection of a bladder tumor followed by intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) is the usual treatment. Disseminated (or systemic) BCG infection (BCGitis) represents the most severe adverse effect of intravesical BCG therapy, presenting with high-grade fever, with or without symptoms in the urinary tract, leading to severe sepsis and death if left untreated. The treatment of choice consists of isoniazid, rifampicin, and ethambutol (with or without corticosteroids) for 6 months, and the recovery rate is extremely high. Given the fact that these drugs are hepatotoxic, treating a patient with liver cirrhosis is challenging. Case Report: We present a patient with a medical history of BC treated with transurethral resection and intravesical BCG therapy, presenting with fever, transaminasemia, and generalized weakness. Liver and bone marrow biopsies revealed liver cirrhosis and granulomas in both organs. A diagnose of BCGitis was made and the patient was treated with isoniazid, rifampicin, and ethambutol; rifampicin was substituted with moxifloxacin after 1 month due to worsening of liver laboratory results, and moxifloxacin was substituted with levofloxacin later on due to tonic-clonic seizures. The patient was treated for 4 more months with levofloxacin and for 7 more months with isoniazid and ethambutol, with no other adverse effects, preserving liver function and achieving cure of BCGitis. Conclusions: We present the case of a cirrhotic patient presenting with fever and deterioration of liver laboratory results, found to have BCGitis, and discuss possible difficulties in diagnosing and treating such patients.

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“…This treatment fails in some patients due to adaptive immune resistance, and the recurrence rate within two years is 40-60% [3,4]. Besides, BCG also has the potential risk of local or systemic infection complications and multi-system diseases [5][6][7]. Existing chemotherapy and radiotherapy methods also have drawbacks such as high toxicity, high side effects, poor e cacy, and chemoresistance [8].…”

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confidence: 99%

Transcriptome and Proteome Analysis Reveals Corosolic Acid Inhibiting Bladder Cancer via Targeting Cell Cycle and Inducing Mitophagy in Vitro and in Vivo

Cui

et al. 2021

Preprint

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Background Existing chemotherapy and radiotherapy methods have drawbacks such as high toxicity, high side effects, poor efficacy, and chemoresistance. Therefore, there is an urgent need to develop new anti-cancer drugs with low toxicity and high efficiency for cancer therapy and the prevention of recurrence. Corosolic acid (CA) is a medicine and food homologue and has many biological activities of health care. However, the anti-tumor effects and mechanism of CA in bladder cancer remain unexplored. Methods To study the anticancer effect of CA on bladder cancer cells, CCK8, EdU, high-content living cell imaging experiments were performed. And the mice model was used to verify the anticancer effect and toxicity for mice. To investigate the molecular mechanism of CA inhibition on bladder cancer cells, transcriptomics and proteomics were employed. To further verify the pharmacological mechanism, flow cytometry, RT-qPCR, western blotting and immunofluorescence staining experiments were performed, and the CA targeting molecules were analyzed in combination with our experimental and public clinical data. Results We found that CA inhibited bladder cancer cell proliferation in a concentration- and time-dependent manner. Xenograft experiments showed that CA inhibited the growth of subcutaneous tumors, and had no toxicity in mice. Integration of omics analysis revealed that low concentrations of CA inhibited bladder cancer cells proliferation via attenuating DNA synthesis by downregulating TOP2A and LIG1, and via diminishing mitosis by downregulating CCNA2, CCNB1, CDC20, and RRM2. High concentrations of CA induced cell death not through the apoptotic pathway but through triggering mitophagy pathway via upregulating SQSTM1/P62, NBR1, and UBB. Conclusions CA, a natural compound homologous to medicine and food, inhibits the mitosis of bladder cancer cells at low concentrations, and kills bladder cancer cells by inducing mitophagy at high concentrations. This study provides a comprehensive understanding of the pharmacological mechanism of CA inhibition in bladder cancer for the first time, which is helpful for the development of new anti-tumor drugs based on CA.

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Disseminated Bacillus Calmette-Guérin (BCG) infection with pulmonary and renal involvement: A rare complication of BCG immunotherapy. A case report and narrative review

Cited by 23 publications

References 31 publications

A unique case of miliary pulmonary tuberculosis induced by bacillus Calmette-Guérin intravesical instillation with COVID-19 superinfection

A unique case of miliary pulmonary tuberculosis induced by bacillus Calmette-Guérin intravesical instillation with COVID-19 superinfection

Difficulties in Diagnosing and Treating Disseminated Bacillus Calmette-Guérin (BCG) Infection After Intravesical BCG Therapy in a Patient with Liver Cirrhosis: A Case Report

Transcriptome and Proteome Analysis Reveals Corosolic Acid Inhibiting Bladder Cancer via Targeting Cell Cycle and Inducing Mitophagy in Vitro and in Vivo

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