Okon Emmanuel, Stearns Janelle, Durgam Arun Kumar
Department of Infectious Diseases, Marshfield Clinic, Eau Claire, WI, USA.
Department of Infectious Diseases, Sacred Heart Hospital, Eau Claire, WI, USA.
Am J Case Rep. 2017 Jul 19;18:810-812. doi: 10.12659/ajcr.903770.
BACKGROUND Intravesical bacillus Calmette-Guerin (BCG) is used in the treatment and prophylaxis of carcinoma in situ of the urinary bladder and for the prophylaxis of primary or recurrent stage Ta and T1 papillary tumors following transurethral resection. Significant systemic complications are rare but have been reported. CASE REPORT We describe this case of Mycobacterium bovis psoas abscess and worsening abdominal aortic aneurysm following BCG therapy for bladder cancer. A 76-year-old male presented with a fever of a few days. He had a computed tomography (CT) scan of abdomen and pelvis that showed left iliopsoas fluid collection measuring 6.7×3.8 cm and an abdominal aortic aneurysm that had almost doubled in size from 4.9 cm to 8.5 cm. The patient underwent CT-guided aspiration of the iliopsoas collection. Mycobacterium bovis was isolated from the aspirate cultures. He had received intravesical BCG therapy for bladder cancer a few years prior. CONCLUSIONS The rapid increase in the size of the abdominal aortic aneurysm (mycotic aneurysm) in our patient was most likely due to BCG therapy. The risk-benefit assessment of this treatment should be carefully considered especially in patients with a pre-existing vascular aneurysm.
背景 膀胱内灌注卡介苗（BCG）用于治疗和预防膀胱原位癌，以及经尿道切除术后预防原发性或复发性Ta和T1期乳头状肿瘤。严重的全身并发症虽罕见但已有报道。病例报告 我们描述了一例膀胱癌患者在接受BCG治疗后发生牛分枝杆菌腰大肌脓肿并伴有腹主动脉瘤病情恶化的病例。一名76岁男性出现发热数天。他接受了腹部和骨盆的计算机断层扫描（CT），结果显示左髂腰肌有6.7×3.8厘米的液性聚集，腹主动脉瘤大小从4.9厘米几乎翻倍至8.5厘米。患者接受了CT引导下的髂腰肌积液抽吸。从抽吸物培养物中分离出牛分枝杆菌。他几年前曾因膀胱癌接受膀胱内BCG治疗。结论 我们患者腹主动脉瘤（感染性动脉瘤）大小的迅速增加很可能是由于BCG治疗。尤其是对于已有血管动脉瘤的患者，应仔细考虑这种治疗的风险效益评估。
