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[Tuberculosis induced by Bacillus Calmette-Guerin immuno-prophylaxis -- case study].
H Frickmann1, S Jungblut, P Hanke
1Medizinische Klinik, St. Elisabethen Krankenhaus, Katharina Kasper Kliniken, Frankfurt/Main.
Pneumologie (Stuttgart, Germany)
|November 10, 2004
Summary
Bacillus Calmette-Guerin (BCG) instillation for bladder cancer can cause miliary tuberculosis. This rare complication, triggered by urethral trauma during catheterization, was successfully treated with antitubercular therapy.
Area of Science:
- Oncology
- Infectious Diseases
- Pulmonology
Background:
- Bacillus Calmette-Guerin (BCG) immunotherapy is a standard treatment for non-muscle-invasive bladder carcinoma.
- Complications from intravesical BCG instillation are typically localized, but systemic dissemination can occur.
Observation:
- A 60-year-old patient developed sepsis with fever four days post-BCG instillation for bladder cancer.
- A difficult catheterization prior to therapy likely caused a urethral lesion, facilitating bacillemia.
- Computed tomography (CT) revealed a miliary pattern suggestive of disseminated infection.
Findings:
- Bronchoscopy with transbronchial biopsy confirmed granulomatous inflammation.
- Acid-fast bacilli were identified in bronchial secretions, confirming tuberculosis.
- The patient's symptoms resolved following a standard triple antitubercular therapy regimen.
Implications:
- This case highlights a rare but serious systemic complication of intravesical BCG therapy.
- Physicians should consider disseminated BCG infection in patients presenting with sepsis post-treatment.
- Prompt diagnosis and appropriate antitubercular treatment are crucial for favorable outcomes.