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[Bilateral tuberculous epididymitis after intravesical Bacillus Calmette-Guerin therapy]

Kazuyoshi Shigehara1, Yoshitomo Kobori, Toshiyasu Amano

  • 1The Department of Urology, Nagano Red Cross Hospital.

Hinyokika Kiyo. Acta Urologica Japonica
|January 31, 2006
PubMed

Insights

Tuberculosis can rarely affect the epididymis following Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. This case highlights a rare complication of BCG instillation, emphasizing the need for vigilance in diagnosing genitourinary tuberculosis.

Area of Science:

  • Urology
  • Oncology
  • Infectious Diseases

Background:

  • Bladder transitional cell carcinoma (TCC) is a common malignancy.
  • Intravesical Bacillus Calmette-Guerin (BCG) is a standard immunotherapy for non-muscle invasive bladder cancer.
  • Recurrence of bladder tumors necessitates treatment consideration.

Observation:

  • A 72-year-old male with a history of bladder TCC underwent transurethral resection.
  • Following intravesical BCG instillation for recurrent papillary tumors, the patient developed bilateral painful scrotal swelling.
  • Symptoms persisted despite initial treatment with isoniazid (INH) and rifampicin (RFP).

Findings:

  • Surgical intervention (right orchiectomy, left epididymectomy) revealed bilateral tuberculous epididymitis.
  • Histopathological confirmation established tuberculosis as the cause of scrotal swelling.
  • Post-operative anti-tuberculosis therapy led to symptom resolution.

Implications:

  • Intravesical BCG therapy can, in rare instances, lead to genitourinary tuberculosis, specifically epididymitis.
  • Clinicians should consider tuberculosis in the differential diagnosis of scrotal swelling after BCG instillation.
  • Prompt diagnosis and appropriate anti-tuberculosis treatment are crucial for managing this BCG complication.

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