Disseminated BCG: Complications of Intravesical Bladder Cancer Treatment
Intravesical bacillus Calmette-Guerin (BCG) has been established as an effective treatment of superficial bladder cancer (Parker and Kommu, 2013). However, major side effects, including pneumonitis, sepsis, and even death, may occur in <5% of patients (Gonzalez et al., 2003). Here we present a ca...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2014-01-01
|
| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2014/362845 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849409188068851712 |
|---|---|
| author | Uyen To Joyce Kim David Chia |
| author_facet | Uyen To Joyce Kim David Chia |
| author_sort | Uyen To |
| collection | DOAJ |
| description | Intravesical bacillus Calmette-Guerin (BCG) has been established as an effective treatment of superficial bladder cancer (Parker and Kommu, 2013). However, major side effects, including pneumonitis, sepsis, and even death, may occur in <5% of patients (Gonzalez et al., 2003). Here we present a case of severe disseminated Mycobacterium bovis following intravesical BCG administration. Our patient is a 76-year-old gentleman with newly diagnosed superficial transitional cell carcinoma of the bladder who recently received his first intravesical BCG treatment. He initially presented with hemoptysis and was found to have extensive patchy infiltrates bilaterally. He was treated for pneumonia with antibiotics and then with steroids for hypersensitivity pneumonitis but continued to deteriorate. Due to the temporal proximity of his exposure to BCG, we administered treatment for presumed disseminated BCG infection with rifampin, isoniazid, and ethambutol. Within a 48-hour period, the patient improved dramatically. The reported cases of infection from intravesical BCG illustrate an insidious onset with initial symptoms of low-grade fevers and cystitis but may progress to pneumonitis. If the symptoms persist for more than 7 days or if there is clinical deterioration, RIPE therapy (with rifampin, isoniazid, pyridoxine, and ethambutol) and a fluoroquinolone should be administered for a 6–9-month course along with steroids for 4–6 weeks (Naudžiunas et al., 2012). |
| format | Article |
| id | doaj-art-7e7350d9cf9b451b844cfd9d84b9871e |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-7e7350d9cf9b451b844cfd9d84b9871e2025-08-20T03:35:34ZengWileyCase Reports in Medicine1687-96271687-96352014-01-01201410.1155/2014/362845362845Disseminated BCG: Complications of Intravesical Bladder Cancer TreatmentUyen To0Joyce Kim1David Chia2Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USAYale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USAYale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USAIntravesical bacillus Calmette-Guerin (BCG) has been established as an effective treatment of superficial bladder cancer (Parker and Kommu, 2013). However, major side effects, including pneumonitis, sepsis, and even death, may occur in <5% of patients (Gonzalez et al., 2003). Here we present a case of severe disseminated Mycobacterium bovis following intravesical BCG administration. Our patient is a 76-year-old gentleman with newly diagnosed superficial transitional cell carcinoma of the bladder who recently received his first intravesical BCG treatment. He initially presented with hemoptysis and was found to have extensive patchy infiltrates bilaterally. He was treated for pneumonia with antibiotics and then with steroids for hypersensitivity pneumonitis but continued to deteriorate. Due to the temporal proximity of his exposure to BCG, we administered treatment for presumed disseminated BCG infection with rifampin, isoniazid, and ethambutol. Within a 48-hour period, the patient improved dramatically. The reported cases of infection from intravesical BCG illustrate an insidious onset with initial symptoms of low-grade fevers and cystitis but may progress to pneumonitis. If the symptoms persist for more than 7 days or if there is clinical deterioration, RIPE therapy (with rifampin, isoniazid, pyridoxine, and ethambutol) and a fluoroquinolone should be administered for a 6–9-month course along with steroids for 4–6 weeks (Naudžiunas et al., 2012).http://dx.doi.org/10.1155/2014/362845 |
| spellingShingle | Uyen To Joyce Kim David Chia Disseminated BCG: Complications of Intravesical Bladder Cancer Treatment Case Reports in Medicine |
| title | Disseminated BCG: Complications of Intravesical Bladder Cancer Treatment |
| title_full | Disseminated BCG: Complications of Intravesical Bladder Cancer Treatment |
| title_fullStr | Disseminated BCG: Complications of Intravesical Bladder Cancer Treatment |
| title_full_unstemmed | Disseminated BCG: Complications of Intravesical Bladder Cancer Treatment |
| title_short | Disseminated BCG: Complications of Intravesical Bladder Cancer Treatment |
| title_sort | disseminated bcg complications of intravesical bladder cancer treatment |
| url | http://dx.doi.org/10.1155/2014/362845 |
| work_keys_str_mv | AT uyento disseminatedbcgcomplicationsofintravesicalbladdercancertreatment AT joycekim disseminatedbcgcomplicationsofintravesicalbladdercancertreatment AT davidchia disseminatedbcgcomplicationsofintravesicalbladdercancertreatment |