Tuberculosis Complications After BCG Treatment for Urinary Bladder Cancer

Abstract

Bacillus Calmette-Guérin (BCG) is an attenuated strain of Mycobacterium bovis that has been effectively used in the treatment of non-muscle invasive bladder carcinoma. The complications of this treatment are uncommon, and the causes of dissemination are still discussed. We report a case of disseminated tuberculosis in a 66-year-old smoking man without a history of pulmonary diseases, who underwent immunotherapy with BCG after the initial surgical treatment of bladder cancer. After the last BCG instillation, he developed a fever. The diagnosis of sepsis was not confirmed, and miliary pulmonary tuberculosis was suspected. The diagnosis was confirmed by clinical manifestation, computed tomography of the lungs, and histological examination.

Disseminated BCG sepsis following intravesical therapy for Bladder Carcinoma: A case report and review of literature

“…Frequency and dysuria, macroscopic hematuria, bladder contracture, ureteral obstruction, prostatitis and epididymo-orchitis can all occur [ 10 ]. Rarely, serious systemic complications can arise in the form of sepsis, pneumonitis, granulomatous hepatitis, reactive arthritis and even death from disseminated BCG can arise in less than 5% of cases [ 5 , 11 ]. These complications may be classified as early or late depending on the timing from intravesical instillation.…”

Recombinant Mycobacterium bovis BCG for immunotherapy in nonmuscle invasive bladder cancer

“…It has been shown that during maintenance of BCG treatment, only 16 % of patients were able to receive all instillations of the 3 years treatment, mainly because of side effects (Lamm et al 2000). Side effects complications can occur as a result of live bacterial use, leading to the appearance of symptoms such as fever, cystitis, pneumonitis, hepatitis, sepsis by BCG, and even death (Brausi et al 2014;Lamm et al 1991;Lamm et al 2000;Lukacs et al 2013;Naudžiunas et al 2012). More than that, treatment-limiting cystitis is observed in approximately 20 % of patients treated with BCG, presumably caused by a combination of increased activation of the immune response and uncontrolled BCG replication.…”

“…More than that, treatment-limiting cystitis is observed in approximately 20 % of patients treated with BCG, presumably caused by a combination of increased activation of the immune response and uncontrolled BCG replication. The most serious complications of BCG immunotherapy for bladder cancer are widely disseminated infection (to the lungs, for example) referred to as BBCGosis^and localized genitourinary tract infection, especially in debilitated patients or those whose immune system is compromised (Gan et al 2013;Lukacs et al 2013;Naudžiunas et al 2012)…”

Disseminated Granulomatous Disease from Intravesical Instillation of Bacillus Calmette-Guerin

“…The induction of local inflammation makes hematuria, cystitis, and transient fevers a common and almost an inherent part of the BCG treatment [ 3 , 4 ]. Systemic complications from BCG therapy, such as pneumonitis, granulomatous hepatitis, and sepsis, are rare and usually occur after traumatic and difficult bladder catheterizations [ 5 , 6 ].…”