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      Infected Aortic Aneurysm caused by Mycobacterium bovis after Intravesical Bacillus Calmette-Guérin Treatment for Bladder Cancer

      case-report

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          Abstract

          A 70-year-old man presented with lower back pain and cyanotic changes in his left lower extremity. He was diagnosed with infected aortic aneurysm and infectious spondylitis. He had received intravesical Bacillus Calmette-Guérin (BCG) therapy up to 1 month before the onset of symptoms. The aneurysm was excised and an aorto-biiliac interposition graft was performed. Mycobacterium tuberculosis complex was cultured in the surgical specimens. Real-time polymerase chain reaction (PCR) targeting the senX3-regX3 region, and multiplex PCR using dual-priming oligonucleotide primers targeting the RD1 gene, revealed that the organism isolated was Mycobacterium bovis BCG. The patient took anti-tuberculosis medication for 1 year, and there was no evidence of recurrence at 18 months follow-up.

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          Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer.

          D L Lamm, A P M van der Meijden, R. MORALES … (1992)
          Intravesical therapy with bacillus Calmette-Guerin (BCG) has proved to be more effective in the prophylaxis and treatment of superficial bladder tumors and carcinoma in situ than most chemotherapeutic agents. Compared to intravesical chemotherapy, instillations with BCG provoke more local and systemic reactions. In addition to the commonly induced granulomatous inflammatory changes in the bladder, which produce irritative symptoms, this therapy may cause systemic side effects varying from mild malaise and fever to, in rare instances, life-threatening or fatal sepsis. We report the incidence and varieties of toxicities in 2,602 patients treated with intravesical BCG. Side effects are classified according to local and systemic toxicity. Treatment options vary according to the severity of toxicity from delaying or withholding instillations to treatment with antituberculous drugs for up to 6 months. In general, 95% of the patients have no serious side effects. Recognition of risk factors, particularly traumatic catheterization or concurrent cystitis, that result in systemic BCG absorption, as well as the prompt and appropriate treatment of early side effects should significantly decrease the incidence of severe toxicity.
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            Spectrum of bacille Calmette-Guérin (BCG) infection after intravesical BCG immunotherapy.

            Omar Gonzalez, Daniel M. Musher, Indira Brar … (2003)
            Intravesical instillation of bacille Calmette-Guérin (BCG) effectively treats transitional cell carcinoma of the bladder. Occasionally, BCG infection complicates such treatment. In some patients, infection appears early (within 3 months after instillation) and is characterized by generalized symptoms, with pneumonitis and hepatitis. Late-presentation disease occurs >1 year after the first BCG treatment and usually involves focal infection of the genitourinary tract (the site at which bacteria were introduced) and/or other sites that are typical for reactivation of mycobacterial disease, such as the vertebral spine or the retroperitoneal tissues. Noncaseating granulomas are found in the majority of cases, whether early or late. Most patients respond to treatment with antituberculous drugs; in early-presentation disease, when features of hypersensitivity predominate, glucocorticosteroids are sometimes added. Late localized infection often requires surgical resection.
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              Susceptibility of Mycobacterium bovis BCG vaccine strains to antituberculous antibiotics.

              Nicole Ritz, Marc Tebruegge, Tom Connell … (2009)
              Mycobacterium bovis BCG is one of the most commonly administered vaccines. Complications, including disseminated BCG disease, are rare but increasingly reported in immunodeficient children. There is growing recognition of the importance of differences between BCG vaccine strains. We determined the susceptibilities of five genetically distinct BCG vaccine strains to 12 antituberculous drugs.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Chemother
                Journal ID (iso-abbrev): Infect Chemother
                Journal ID (publisher-id): IC
                Title: Infection & Chemotherapy
                Publisher: The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
                ISSN (Print): 2093-2340
                ISSN (Electronic): 2092-6448
                Publication date (Print): December 2015
                Publication date (Electronic): 30 December 2015
                Volume: 47
                Issue: 4
                Pages: 256-260
                Affiliations
                [1 ]Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
                [2 ]Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
                [3 ]Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
                [4 ]Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
                Author notes
                Corresponding Author: Pyoeng Gyun Choe, MD. Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-4187, Fax: +82-2-762-9662, draver@ 123456snu.ac.kr
                Author information
                http://orcid.org/0000-0003-2488-3226
                http://orcid.org/0000-0001-6794-7918
                Article
                DOI: 10.3947/ic.2015.47.4.256
                PMC ID: 4716278
                PubMed ID: 26788410
                SO-VID: a1ed0655-00d8-4f7d-af50-dbe386832bb7
                Copyright © Copyright © 2015 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 May 2014
                Date revision received : 11 July 2014
                Date accepted : 11 July 2014
                Categories
                Subject: Case Report

                Keywords: mycobacterium bovis,aneurysm, infected,spondylitis,administration, intravesical
                Data availability:
                Keywords: mycobacterium bovis, aneurysm, infected, spondylitis, administration, intravesical

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