Elmer A, Bermes U, Drath L, Büscher E, Viertel A
Medizinische Klinik I, St. Josefs-Hospital, Wiesbaden.
Urologe A. 2004 Dec;43(12):1537-40. doi: 10.1007/s00120-004-0707-2.
Local Bacillus Calmette-Guerin (BCG) immunotherapy is an effective and widely used treatment for superficial bladder carcino-ma. Local side effects are frequent, where-as systemic side effects are rare, but more serious. Systemic BCG infection as a life-threatening complication of intravesical BCG instillation should be suspected in any patient who presents with persistent fever after BCG instillation for bladder cancer.A 62-year-old patient had been treated with 6 intravesical BCG instillations for recurrent, multifocal bladder carcinoma.4 weeks after the last instillation, he presented with fever, malaise and scleral icterus. Laboratory tests revealed abnormal li-ver function tests, panzytopenia and signs of coagulation disorder. Bone marrow biopsy and liver biopsy showed non-caseating granulomas. Systemic BCG infection was suspected and antituberculous therapy combined with steroids was started. The patient developed severe sepsis and suffered from multiple organ failure. Despite partial improvement, the course was complicated by intracranial sinus thrombosis, and the patient died two month after admission.
局部卡介苗（BCG）免疫疗法是浅表性膀胱癌一种有效且广泛应用的治疗方法。局部副作用较为常见，而全身副作用罕见，但更为严重。对于任何在膀胱癌卡介苗膀胱灌注后持续发热的患者，都应怀疑发生了作为膀胱内卡介苗灌注危及生命并发症的全身性卡介苗感染。一名62岁患者因复发性多灶性膀胱癌接受了6次卡介苗膀胱灌注治疗。最后一次灌注后4周，他出现发热、不适和巩膜黄疸。实验室检查显示肝功能检查异常、全血细胞减少和凝血障碍迹象。骨髓活检和肝活检显示非干酪样肉芽肿。怀疑发生全身性卡介苗感染，开始抗结核治疗并联合使用类固醇。患者发生严重脓毒症并出现多器官功能衰竭。尽管有部分改善，但病程因颅内窦血栓形成而复杂化，患者入院两个月后死亡。
