Nadasy Krisztina A, Patel Rikin S, Emmett Michael, Murillo Ricardo A, Tribble Marc A, Black Robert D, Sutker William L
Baylor University Medical Center, Dallas, Texas 75246, USA.
South Med J. 2008 Jan;101(1):91-5. doi: 10.1097/SMJ.0b013e31815d4047.
Intravesical BCG (bacillus Calmette-Guérin) instillation is a first-line treatment for superficial transitional cell carcinoma of the bladder. A rare but severe complication of BCG immunotherapy is the development of disseminated BCG disease, which can result in miliary pneumonitis, granulomatous hepatitis, soft tissue infections, bone marrow involvement, and sepsis. Symptoms can present as early as a few hours or as late as several months following the BCG therapy. The key finding in disseminated BCG disease is the formation of caseating granulomas in distant organs; detection of BCG organisms from tissue samples can be difficult. Recommended treatment for disseminated BCG disease includes a combination of antituberculous medications (with the exception of pyrazinamide, to which BCG is typically resistant) and a tapering course of steroids. We present the cases of four patients who developed granulomatous infection consistent with disseminated disease after intravesical BCG treatment and provide a summary of current clinical management recommendations.
膀胱内灌注卡介苗（BCG）是浅表性膀胱移行细胞癌的一线治疗方法。卡介苗免疫疗法一种罕见但严重的并发症是播散性卡介苗病的发生，这可能导致粟粒性肺炎、肉芽肿性肝炎、软组织感染、骨髓受累和败血症。症状最早可在卡介苗治疗后数小时出现，最晚可在数月后出现。播散性卡介苗病的关键发现是在远处器官形成干酪样肉芽肿；从组织样本中检测卡介苗生物体可能很困难。播散性卡介苗病的推荐治疗方法包括联合使用抗结核药物（吡嗪酰胺除外，卡介苗通常对其耐药）和逐渐减量的类固醇疗程。我们报告了4例患者在膀胱内卡介苗治疗后发生与播散性疾病一致的肉芽肿感染的病例，并提供了当前临床管理建议的总结。
