Hepapatitis granulomatosa por Mycobacterium complex secundaria a instilación intravesical con BCG

Villamil-Cajoto, Iago; Jove, Maria Jesús; Serrano, Marta; Pousa, Montserrat

doi:10.1016/j.eimc.2010.06.003

Cited by 4 publications

(2 citation statements)

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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%

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%

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

et al. 2014

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“…Sin embargo la no demostración de micobacterias no descarta el diagnóstico más aún si la sospecha es alta 3 , ya que según reportes las pruebas fueron positivos solo en un 42% 1,2 por lo que el diagnostico no es sencillo 3 . Los datos que apoyan un mecanismo de hipersensibilidad (tipo IV) son: estudios microbiológicos negativos, granulomas no caseificantes (positivos en un 86% de casos, siendo el pulmón, la medula ósea y el hígado las zonas de mayor rendimiento para su identificación) 4 e infiltrados esosinófilos en las biopsias, buena respuesta a glucocorticoides 2,4 y/o antituberculosos 2 . Presentamos el siguiente caso con el objetivo de describir las complicaciones por BCG.…”

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Sepsis con afectación peritoneal por BCG: A propósito de un caso

Condori Bustillos,

De la Fuente Olmos,

Villacastín Ruiz

et al. 2023

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La instilacion intravesical de BCG es utilizado en el tratamiento del carcinoma vesical in situ, generalmente es bien tolerada y con raras complicaciones, sobre estas se ha descrito mecanismos por diseminación hematógena (con pruebas microbiológicas e histopatológicas positivas) o por hipersensibilidad tipo IV (Pruebas microbiológicas negativas, granulomas y buena respuesta a corticoides) o mixto. Presentamos el caso de un paciente con Carcinoma vesical en tratamiento con instilaciones intravesicales de BCG, con factores de riesgo de lesión de la barrera urotelial, comienza con fiebre hasta llegar a una sepsis, con cultivos: negativos y en pruebas de imagen: engrosamiento peritoneal con adenopatías necróticas de nueva aparición, negativas para malignidad tras la biopsia dado el antecedente neoplásico del paciente, patrón miliar en TC tórax, evolucionando con buena respuesta a antituberculosos. Dada la relación temporal los hallazgos clínico, radiológicos e histopatológicos se llega al diagnóstico de Sepsis por hipersensibilidad a BCG con afectación peritoneal.

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