Ziegler Jennifer, Ho Julie, Gibson Ian W, Nayak Jasmir G, Stein Markus, Walkty Andrew, Orr Pamela
Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Department of Immunology, University of Manitoba, Winnipeg, MB, Canada.
Transpl Infect Dis. 2018 Oct;20(5):e12931. doi: 10.1111/tid.12931. Epub 2018 Jun 13.
Intravesical Bacillus Camlette-Guérin (BCG) is the treatment of choice for non-muscle invasive bladder cancer, and has been used successfully for over 40 years. A rare and potentially fatal complication of intravesical BCG therapy is BCG-induced sepsis. We report a rare case in which a patient with end-stage renal disease secondary to chronic granulomatous interstitial nephritis underwent remote, pre-transplant intravesical BCG treatment for high-grade non-invasive papillary bladder carcinoma. The patient subsequently received a deceased donor kidney transplant 5 years after BCG therapy, with thymoglobulin induction therapy and standard triple maintenance immunosuppression. Two years post-transplant, he developed BCG-induced sepsis confirmed by cultures from urine, blood, and left native kidney biopsy. He died from disseminated BCG-induced sepsis and failure of his renal allograft. This case highlights the potential adverse reactions associated with intravesical BCG therapy that may occur years after bladder cancer therapy is completed, and should heighten physician awareness for BCG-related infections during pre-transplant assessment and post-transplant care of solid organ transplants recipients.
膀胱内灌注卡介苗（BCG）是非肌层浸润性膀胱癌的首选治疗方法，已成功应用40多年。膀胱内BCG治疗罕见且可能致命的并发症是BCG诱导的败血症。我们报告了一例罕见病例，一名因慢性肉芽肿性间质性肾炎继发终末期肾病的患者，为治疗高级别非侵袭性乳头状膀胱癌接受了远距离、移植前膀胱内BCG治疗。该患者在BCG治疗5年后接受了 deceased donor肾移植，采用了胸腺球蛋白诱导治疗和标准三联维持免疫抑制。移植后两年，他发生了BCG诱导的败血症，尿液、血液和左肾活检培养确诊。他死于播散性BCG诱导的败血症和肾移植失败。该病例突出了膀胱内BCG治疗可能在膀胱癌治疗完成数年之后出现的潜在不良反应，应提高医生在实体器官移植受者移植前评估和移植后护理期间对BCG相关感染的认识。
