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

Abstract

We present a case of isolated renal tuberculosis following bacillus Calmette-Guérin (BCG) therapy for bladder cancer. In the presurgical radiographic examination, we suspected an atypical renal cell carcinoma. According to the diagnosis of renal cell carcinoma, we performed a radical nephrectomy. The histological findings were tuberculosis-specific inflammatory changes and the patient received an antituberculous multiple drug therapy for a year. It is concluded that we should pay attention to the possibility of a renal tuberculosis granuloma in any patient who presented with subacute formed renal masses following BCG treatment before deciding on the strategy of the treatment of the renal masses, especially in patients who had received such a treatment which induced an immunocompromised state.

BCG-Related Renal Granulomas Managed Conservatively

“…Except for two case reports by Rocha and Wada, all of the reported cases of renal granulomas presented with systemic constitutional symptoms of fever. [3][4][5][6][7][8][9][10][11][12]16,20 Perhaps the absence of fever in the two cases presented here could be related to the dose and strain of BCG used. Whereas in these two cases, 50 mg of BCG Tice strain was used, previous reports of febrile renal granulomas were reported with BCG Connaught strain 5,11,16 or BCG Tice strain at higher dose of 120 mg per installation.…”

“…10,12,16 When analyzing available published case reports on renal granulomas, we found that most cases reported multifocality of renal granulomas with multiple renal masses on imaging studies, 4,8,[11][12]16 while others reported solitary renal foci. 5,7,9,10 Both patients in the present series had multiple renal granulomas. Another sign is the "central unaffected calyx sign" on delayed phase CT images that has been previously described in patient with a renal BCG granuloma.…”

“…Except for the case report by Mody and colleagues, in which the patient underwent nephroureterectomy, all of previous case reports of renal granulomas were treated with 6 to 12 months of anti-tuberculous medications. [3][4][5][6][7][8][9][10][11][12]16,20 Therefore, here we present two cases of asymptomatic renal granulomas that were managed without anti-tuberculous medications. However, the reason we were able to manage these patients without anti-tuberculous medications was related to the absence of fever and systemic symptoms.…”

“…3 A small number of granulomatous renal masses following intravesical BCG have been previously reported. [3][4][5][6][7][8][9][10][11][12] The incidence of such renal granulomas has been reported at a rate of 0.1% (2 cases out of 2602). 3 However, previous cases were managed with nephroureterectomy, anti-tuberculous medications or both.…”

Peritoneal tuberculosis and granulomatous hepatitis secondary to treatment of bladder cancer with Bacillus Calmette-Guérin

“…Local side effects due to BCG administration are frequent (90%), and may include hematuria, and dysuria along with cystitis [ 3 ]. Various other local and systemic side effects such as acute respiratory failure and septic shock [ 4 ], hemolytic uremic syndrome, disseminated intravascular coagulation, sepsis, multi-organ failure [ 5 , 6 ], isolated renal tuberculosis (TB) [ 7 ], granulomatous hepatitis [ 8 , 9 ], peritonitis [ 10 ], pancytopenia, epididymo-orchitis [ 11 ], and diffuse granulomatous mesenteric disease [ 12 ] have also been reported. Steg et al described a 3% and Lamm et al around 0.7% incidence of BCG-related granulomatous hepatitis [ 3 , 13 ].…”