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[Miliary dissemination with pulmonary involvement secondary to intravesical immunotherapy with Calmette-Guérin
C Paredes Arranz1, J F de Frutos Arribas, J Calleja Escudero
1Sección de Neumología, Hospital del Río Hortega, Valladolid.
Insights
A patient treated with Calmette-Guérin bacillus solution (CGB) for bladder cancer developed miliary tuberculosis due to CGB. This rare complication, hematogenous dissemination, requires early suspicion and treatment for improved prognosis.
Area of Science:
- Oncology
- Infectious Diseases
- Urology
Background:
- Superficial transitional carcinoma of the bladder is often treated with transurethral resection and immunotherapy.
- Intravesical immunotherapy with Calmette-Guérin bacillus solution (CGB) is a standard treatment for non-muscle invasive bladder cancer.
Observation:
- A 67-year-old male patient received CGB immunotherapy following transurethral resection for bladder cancer.
- Post-treatment, the patient presented with fever, asthenia, and anorexia, leading to hospitalization.
Findings:
- Diagnostic tests confirmed miliary tuberculosis, a disseminated form of tuberculosis, as a complication of CGB therapy.
- Despite initiating tuberculostatic therapy, the patient succumbed to the disseminated infection.
Implications:
- Hematogenous dissemination of CGB is a rare but potentially fatal complication of intravesical immunotherapy.
- Clinicians should maintain a high index of suspicion for CGB-induced miliary tuberculosis in patients presenting with compatible symptoms.
- Early recognition and prompt initiation of appropriate anti-tuberculosis treatment are crucial for improving patient outcomes and survival rates.
Abstract:
We describe the case of a 67-years-old man who underwent transurethral resection and immunotherapy with Calmette-Guérin bacillus solution (CGB) for superficial transitional carcinoma of the bladder. After a series of intravesical irrigations with CGB, the patient developed fever, asthenia and persistent anorexia and was hospitalized. After testing he was diagnosed of miliary tuberculosis due to CGB and died in spite of tuberculostatic therapy. Hematogenous dissemination, a rare but serious complication of vesical irrigation with CGB, is thought to be more common than previously suspected. It should be suspected in all patients receiving CGB when a compatible clinical picture presents. An understanding of this complication and early establishment of specific treatment is the only wat to improve prognosis.
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