膀胱内卡介苗治疗后与牛分枝杆菌相关的主动脉瘤和主动脉移植物感染：病例系列。
Aortic aneurysm and aortic graft infection related to Mycobacterium bovis after intravesical Bacille Calmette-Guérin therapy-a case series.
机构信息
Department of Vascular and Endovascular Surgery, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstraße 10, 10117, Berlin, Germany.
出版信息
BMC Surg. 2021 Mar 17;21(1):138. doi: 10.1186/s12893-021-01142-1.
BACKGROUND
So called "mycotic" aortic aneurysms account for only 0.7 to 1.3% of all aortic aneurysms and are commonly caused by Staphylococcus aureus and Salmonella species. Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, is part of the therapy of non-muscle-invasive bladder cancer (NMIBC).
CASE PRESENTATION
We report a case series of three patients with a mycobacterial graft infection related to BCG after surgical treatment of a presumed mycotic aortic aneurysm as an extremely rare complication after NMIBC treatment. All three patients developed aortic aneurysm after BCG instillation and subsequent mycobacterial graft infection.
CONCLUSION
Diagnosis requires a high degree of suspicion because of its nonspecific symptoms and imaging. The pathogen is not detected by standard microbiological testing. Treatment includes triple antimycobacterial therapy and radical surgical interventions. Graft preservation may be considered if no anastomosis is involved.
背景
所谓的“真菌性”主动脉瘤仅占所有主动脉瘤的 0.7%至 1.3%，通常由金黄色葡萄球菌和沙门氏菌引起。卡介苗（BCG）是减毒活牛分枝杆菌株，是治疗非肌肉浸润性膀胱癌（NMIBC）的一部分。
病例介绍
我们报告了三例患者的病例系列，他们在疑似真菌性主动脉瘤的手术后，由于 NMIBC 治疗后的一种极为罕见的并发症，发生了与 BCG 相关的分枝杆菌移植物感染。所有三名患者在 BCG 灌注后均出现了主动脉瘤，并随后发生了分枝杆菌移植物感染。
结论
由于其非特异性症状和影像学表现，诊断需要高度怀疑。病原体无法通过标准微生物检测检出。治疗包括三联抗分枝杆菌治疗和根治性手术干预。如果不涉及吻合，可考虑保留移植物。
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