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

Gao, Cindy; Mithani, Rozina; Leya, Jack; Dawravoo, Lesley; Bhatia, Arvin; Antoine, John; Alba, Felipe De; Russo, Peter; Fimmel, Claus J.

doi:10.1186/1471-2334-11-260

Cited by 23 publications

(14 citation statements)

References 12 publications

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“… 172 The advent of molecular-based techniques (that is, PCR assay) has progressively modified our understanding of the pathogenesis of BCG infection, as it has lead to the increase in the overall rate of microbiologic diagnosis seen throughout the period encompassed by our review (42.1% in cases reported in 1975–1999 vs 52.5% in those reported in 2000–2013). 85 The detection of M. tuberculosis complex DNA in locations distant from the genitourinary tract, such as lung, 29 , 31 , 104 , 211 liver, 63 , 108 , 222 aortic wall, 227 or periprosthetic hip joint 164 samples, reinforces the hypothesis that the direct invasion and hematogenous spread of BCG underlie the development of the complication, rather than a mere hypersensitivity reaction. In keeping with this rationale, M. bovis has been recovered from the synovial fluid of patients with polyarthritis, 13 , 219 a manifestation generally deemed as immune-mediated.…”

Section: Discussionmentioning

confidence: 62%

“…Chest imaging also play a crucial role in diagnosing disseminated BCG infection and the present review suggests that CT scan should always be preferred over conventional radiography, as the latter technique failed to reveal a miliary pattern in about one-quarter of the patients eventually found to have miliary tuberculosis. 11 , 29 , 37 , 39 , 46 , 63 , 85 , 117 , 141 , 142 , 177 , 214 , 231…”

Section: Discussionmentioning

confidence: 99%

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Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

et al. 2014

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Bacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0–9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p < 0.001 for all comparisons). Attributable mortality was higher for patients aged ≥65 years (7.4% vs 2.1%; p = 0.091) and those with disseminated infection (9.9% vs 3.0%; p = 0.040) and vascular involvement (16.7% vs 4.6%; p = 0.064). The scheduled BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

et al. 2014

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“…Although it is not possible to definitely prove that intravesicular BCG caused bilateral corneal melting in our patient, we presume that this was an immune reaction in the absence of any other contributing factor. The possibility of an infective etiology by active mycobacterium must also be considered[18] though AFB stain and culture was negative in our case.…”

Section: Discussionmentioning

confidence: 94%

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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“…La littérature fait état de plusieurs observations d'atteintes diffuses par la BCG, ou BCGites généralisées. Les principales localisations décrites sont celles retrouvées chez notre patient et concernent les poumons, le foie, l'aorte, les articulations périphériques et le rachis (spondylodiscite), l'oeil, la moelle osseuse [7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Discussionunclassified

Hépatite granulomateuse révélant une infection disséminée à Mycobacterium bovis après BCG-thérapie intravésicale

Raffray¹,

Riviere²,

Bonnet³

et al. 2015

La Revue de Médecine Interne

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

Cited by 23 publications

References 12 publications

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

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

Hépatite granulomateuse révélant une infection disséminée à Mycobacterium bovis après BCG-thérapie intravésicale

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