Coscas Raphael, Arlet Jean-Benoît, Belhomme Denis, Fabiani Jean-Noël, Pouchot Jacques
Department of Cardiovascular Surgery, Faculté de Médecine Paris Descartes et Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
J Vasc Surg. 2009 Nov;50(5):1185-90. doi: 10.1016/j.jvs.2009.06.004. Epub 2009 Aug 5.
Mycotic aneurysms are exceptional complications after intravesical instillations of bacillus Calmette-Guérin (BCG) for bladder carcinoma. We report a patient who underwent an emergency operation for a ruptured carotid aneurysm 16 months after BCG therapy. Postoperative investigations discovered multiple other synchronous aneurysms. Culture of an abscess surrounding the right carotid artery identified Mycobacterium bovis var BCG. The patient improved clinically with antituberculous agents prescribed for 9 months but died from recurrence of bladder carcinoma 16 months later. A mycotic origin should be evoked when an aneurysm is discovered after BCG therapy. Microbiologic investigation of the artery wall is diagnostic.
霉菌性动脉瘤是卡介苗（BCG）膀胱内灌注治疗膀胱癌后罕见的并发症。我们报告1例患者，在接受BCG治疗16个月后因颈动脉动脉瘤破裂接受了急诊手术。术后检查发现还有其他多个同步存在的动脉瘤。右颈动脉周围脓肿培养发现牛型结核分枝杆菌卡介苗变种。患者接受9个月抗结核药物治疗后临床症状改善，但16个月后死于膀胱癌复发。BCG治疗后发现动脉瘤时应考虑霉菌性病因。动脉壁的微生物学检查具有诊断意义。
