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

Abstract

Mycotic aneurysms are exceptional complications after intravesical instillations of bacillus Calmette-Guérin (BCG) for bladder carcinoma. We report a patient who underwent an emergency operation for a ruptured carotid aneurysm 16 months after BCG therapy. Postoperative investigations discovered multiple other synchronous aneurysms. Culture of an abscess surrounding the right carotid artery identified Mycobacterium bovis var BCG. The patient improved clinically with antituberculous agents prescribed for 9 months but died from recurrence of bladder carcinoma 16 months later. A mycotic origin should be evoked when an aneurysm is discovered after BCG therapy. Microbiologic investigation of the artery wall is diagnostic.

Combined infection of vertebroplasty and aortic graft after intravesical BCG treatment

“…The mean time of diagnosis was 23 months after BCG-therapy (range 4–69 months). The most frequent clinical symptoms at presentation were abdominal or back pain (57%), general malaise, a pulsatile or a painful abdominal mass and fever 10. Our patient suffered from back pain, weight loss and night sweats.…”

Mycotic Thoracic Aortic Aneurysm After Intravesical Bacillus Calmette–Guérin Treatment

“…The majority of patients present with aneurysm rupture, as in our patient, and the aneurysms typically involve the abdominal aorta. Bacillus Calmette-Gu erin-associated mycotic aneurysms of the carotid, femoral, iliac, and popliteal arteries have also been reported, with only 2 cases of thoracic aorta involvement, neither of which was treated surgically [2][3][4][5][6][7].…”

“…The majority of patients with aneurysms at other vascular sites were treated successfully with a combination of surgery and antimycobacterial medications [3]. There were no reported cases of recurrence at followup.…”

“…Giant aneurysms are broadly defined as having a diameter greater than 2 cm to 5 cm [2] and are increasingly more atypical than less pronounced aneurysms (prevalence of 0.02% in a 30,268-member surgical population) [3]. Giant aneurysms have no established definitive treatment, although surgical resection is the most commonly reported remedy.…”

“…In a series of 2,500 patients, infectious complications were noted in less than 1% of patients [2]. To date, fewer than 30 cases of BCG-associated mycotic aneurysms have been reported, with only 2 cases involving the thoracic aorta [3][4][5][6][7][8]. We have described the first case of an M bovis mycotic thoracic aorta aneurysm that was successfully treated with resection.…”