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[Incomplete Reiter syndrome caused by BCG instillation : a case report]

Daichi Nonomura1, Kinzo Katayama, Keigo Madono

  • 1Sumitomo Hospital Urology, Japan.

Hinyokika Kiyo. Acta Urologica Japonica
|May 3, 2013
PubMed

Insights

Intravesical bacillus Calmette Guérin (BCG) therapy for bladder cancer can rarely cause Reiter syndrome, a serious inflammatory condition. Prompt diagnosis and treatment are crucial for symptom improvement in patients experiencing this uncommon side effect.

Area of Science:

  • Urology
  • Immunology
  • Rheumatology

Background:

  • Intravesical bacillus Calmette Guérin (BCG) is a standard treatment for non-muscle invasive bladder cancer.
  • Complications of BCG immunotherapy can include systemic inflammatory responses.
  • Reiter syndrome, a reactive arthritis, is an uncommon but recognized adverse event associated with BCG therapy.

Observation:

  • A 91-year-old male patient undergoing intravesical BCG for upper urinary carcinoma in situ developed fever, arthralgia, and back pain after the fourth treatment cycle.
  • Symptoms persisted despite antibiotic treatment, leading to a diagnosis of Reiter syndrome.
  • The patient received a combination of antitubercular agents, NSAIDs, and corticosteroids.

Findings:

  • Reiter syndrome manifested as a systemic inflammatory reaction following intravesical BCG immunotherapy.
  • Treatment with a multi-drug regimen including antitubercular agents, NSAIDs, and corticosteroids led to symptom resolution.
  • Complete symptom improvement was observed 17 days after the onset of adverse effects.

Implications:

  • This case highlights Reiter syndrome as a rare but significant complication of intravesical BCG therapy.
  • Clinicians should maintain a high index of suspicion for reactive arthritis in patients presenting with systemic symptoms post-BCG treatment.
  • Vigilant monitoring for severe side effects and timely intervention are essential in managing patients undergoing BCG immunotherapy.

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