scholarly journals A Case of Pott’s Disease with Epidural Abscess and Probable Cerebral Tuberculoma following Bacillus Calmette-Guérin Therapy for Superficial Bladder Cancer

2010 ◽  
Vol 21 (1) ◽  
pp. e75-e78 ◽  
Author(s):  
Colin B Josephson ◽  
Saleh Al-Azri ◽  
Daniel J Smyth ◽  
David Haase ◽  
B Lynn Johnston
Keyword(s):  
Interferon Alpha ◽  
Epidural Abscess ◽  
Transitional Cell ◽  
Vertebral Osteomyelitis ◽  
Systemic Infection ◽  
Late Presentation ◽  
Bacillus Calmette Guerin ◽  
Interferon Alpha 2B ◽  
Intravesical Bcg ◽  
Cerebral Tuberculoma

Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is an accepted treatment for transitional cell carcinoma of the bladder. Carcinoma in situ of the bladder progresses to invasive muscular disease in approximately 54% of untreated patients, mandating early initiation of therapy once the diagnosis is confirmed. Should BCG treatment fail, an additional course of BCG combined with interferon-alpha, both administered intravesically, is a promising second-line immunotherapy. In greater than 95% of patients, BCG is tolerated without significant morbidity or mortality. However, both early (within three months of the original treatment) and late presentations of systemic infection resulting from intravesical BCG treatment have been described. The present study describes the course of a 75-year-old man with a late presentation of BCG vertebral osteomyelitis, discitis, epidural abscess, bilateral psoas abscesses and probable cerebral tuberculoma, following treatment regimens of intravesical BCG followed by intravesical BCG plus interferon-alpha 2b.

scholarly journals A Case of Acquired Rifampin Resistance inMycobacterium bovisBacillus Calmette-Guérin-Induced Cystitis: Necessity for Treatment Guidelines

2006 ◽  
Vol 17 (3) ◽  
pp. 183-185 ◽  
Author(s):  
Joyce N Wolfe ◽  
Kym S Blackwood-Antonation ◽  
Meenu K Sharma ◽  
Victoria J Cook
Keyword(s):  
Drug Resistance ◽  
Target Gene ◽  
Treatment Guidelines ◽  
Transitional Cell ◽  
Bacillus Calmette Guerin ◽  
Acquired Drug Resistance ◽  
Elderly Female ◽  
Intravesical Bcg ◽  
Rifampin Resistance ◽  
Bcg Instillation

A case of presumed bacillus Calmette-Guérin (BCG) cystitis in an elderly female patient following direct intravesical BCG instillation treatment for papillary transitional cell carcinoma is reported. The organism cultured from urine samples was eventually identified as a rifampin-resistantMycobacterium bovisBCG isolate. Because the patient had received rifampin monotherapy during the course of treatment for presumed BCG disease, the clinical picture favoured acquired rifampin resistance. Sequencing of the target gene for rifampin (rpoB) confirmed a known mutation responsible for conferring high levels of resistance to both rifampin and rifabutin (Ser531Tyr). To the authors' knowledge, this is the first reported case ofM bovisBCG disease in a non-HIV patient where the organism had acquired drug resistance to rifampin, and the second reported case ofM bovisBCG that had acquired drug resistance. The present case demonstrates the necessity to re-evaluate appropriate guidelines for the effective treatment of BCG disease.

scholarly journals Disseminated Mycobacterium Bovis Infection Complicating Intravesical BCG Instillation for the Treatment of Superficial Transitional Cell Carcinoma of the Bladder

2016 ◽  
Vol 9 ◽  
pp. CCRep.S39904 ◽  
Author(s):  
Fatehi Elzein ◽  
Nada Albogami ◽  
Mustafa Saad ◽  
Nazik El Tayeb ◽  
Abdullah Alghamdi ◽  
...  
Keyword(s):  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Early Recognition ◽  
Transitional Cell ◽  
Late Presentation ◽  
Intravesical Instillation ◽  
Antituberculosis Treatment ◽  
Intravesical Bcg ◽  
Carcinoma Of The Bladder ◽  
Bcg Instillation

Background Intravesical instillation of Bacillus Calmette–Guérin (BCG) remains a first-line treatment for superficial transitional cell carcinoma of the bladder. Although its use is relatively safe, severe complications such as granulomatous hepatitis, osteomyelitis, pneumonitis, and sepsis occur in few patients. Complications of intravesical instillation of BCG can be local or systemic, with early or late presentation. Case Presentation Here, we report an 88-year-old man who developed fever, rigors, and episodes of syncope following fourth intravesical BCG instillation for the treatment of superficial transitional cell carcinoma of the bladder. Pancytopenia, disseminated intravascular coagulation, ground glass appearance on computerized tomography of the chest scan in addition to multiple bone marrow granulomas, suggested the diagnosis of disseminated BCG infection. All these features recovered on antituberculosis treatment. Conclusion Our case study highlights the importance of early recognition and prompt treatment of patients with disseminated BCG infection following intravesical instillation. Although isolation of mycobacterium is desirable to make the diagnosis, it is not unusual to have negative smears and cultures and this should not be used to dismiss the possibility of BCG infection.

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