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[Complications after intravesical BCG instillation].

Bastiaan M Privé1,2, H M Bruins1, Bert Mulder3

  • 1Canisius-Wilhelmina Ziekenhuis, afd. Urologie, Nijmegen.

Nederlands Tijdschrift Voor Geneeskunde
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Intravesical Mycobacterium bovis BCG immunotherapy for bladder cancer can cause rare but serious complications like BCG pneumonia, arthritis, and cystitis. Early diagnosis and specific treatment are crucial due to non-specific symptoms and diagnostic challenges.

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Area of Science:

  • Oncology
  • Immunology
  • Infectious Diseases

Background:

  • Intravesical Mycobacterium bovis BCG is a primary immunotherapy for high-grade urothelial cell carcinoma of the bladder.
  • BCG immunotherapy activates the immune system to reduce cancer recurrence.
  • Rare complications include mycobacterial infections and systemic immune reactions.

Purpose of the Study:

  • To highlight the diagnostic challenges and treatment of rare Mycobacterium bovis BCG complications.
  • To present cases of BCG pneumonia, arthritis, and cystitis.
  • To review the history, pathophysiology, clinical presentation, diagnostics, and treatment of BCG complications.

Main Methods:

  • Case series presentation of three patients with BCG-related complications.
  • Review of the literature on Mycobacterium bovis BCG immunotherapy and its adverse events.

Main Results:

  • Three patients presented with distinct BCG complications: pneumonia, arthritis, and cystitis.
  • Symptoms of BCG complications are often non-specific, complicating diagnosis.
  • Current diagnostic methods (cultures, PCR, imaging) may fail to detect M. bovis infections promptly.

Conclusions:

  • Mycobacterium bovis BCG complications require heightened clinical suspicion due to non-specific symptoms and diagnostic limitations.
  • Delayed diagnosis can result from challenges in detecting M. bovis infections.
  • Effective treatment necessitates recognizing these specific complications, as M. bovis is resistant to standard antibiotics.