Larsen Brandon T, Smith Maxwell L, Grys Thomas E, Vikram Holenarasipur R, Colby Thomas V
University of Arizona, Tucson, AZ, USA
Mayo Clinic, Scottsdale, AZ, USA.
Int J Surg Pathol. 2015 May;23(3):189-95. doi: 10.1177/1066896914567332. Epub 2015 Jan 22.
Intravesical instillation of Bacillus Calmette-Guérin (BCG) is a mainstay of adjunctive therapy for superficial bladder cancer. Disseminated BCG infection ("BCG-osis") after this therapy is rare and potentially life-threatening; only isolated case reports detail the histopathologic findings thereof, few of which had a diagnosis confirmed by molecular testing. We report 3 additional cases of BCG-osis complicating BCG therapy, all confirmed by cultures and molecular assays, including the first cases of wedge biopsy-confirmed BCG pneumonia and BCG olecranon bursitis. When suggested by a relevant clinical history, recognition of randomly distributed granulomas in any organ should prompt consideration of BCG-osis and liberal performance of AFB stains, aided by targeted molecular assays. Physicians should maintain a high index of suspicion when miliary infiltrates arise after intravesical BCG instillation, and close multidisciplinary communication is essential. Pathologist awareness of this rare cause of granulomatous inflammation aids recognition of BCG-osis and facilitates prompt initiation of antimycobacterial therapy.
膀胱内灌注卡介苗（BCG）是浅表性膀胱癌辅助治疗的主要手段。该治疗后发生播散性BCG感染（“BCG病”）较为罕见，但可能危及生命；仅有个别病例报告详细描述了其组织病理学表现，其中很少有通过分子检测确诊的。我们报告了另外3例BCG治疗并发BCG病的病例，均通过培养和分子检测确诊，包括首例经楔形活检确诊的BCG肺炎和BCG鹰嘴滑囊炎。当有相关临床病史提示时，在任何器官中识别随机分布的肉芽肿应促使考虑BCG病，并在靶向分子检测的辅助下，积极进行抗酸染色。膀胱内灌注BCG后出现粟粒样浸润时，医生应保持高度怀疑，密切的多学科沟通至关重要。病理学家对这种肉芽肿性炎症的罕见病因有所认识，有助于识别BCG病，并促进抗分枝杆菌治疗的及时启动。
