Umemoto Tatsuya, Naruse Jun, Usui Yukio, Zakoji Hidenori, Miyakita Hideshi, Miyajima Akira
Department of Urology, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan.
Department of Urology, Tokai University Oiso Hospital, 21-1, Gakkyo, Oiso-machi, Naka-gun, Kanagawa 259-0198, Japan.
Case Rep Urol. 2021 Jul 9;2021:5548054. doi: 10.1155/2021/5548054. eCollection 2021.
Bacillus Calmette-Guérin (BCG) instillation is an established therapy for the treatment of carcinoma in situ (CIS) of the bladder and prevention of recurrence after transurethral resection of bladder tumor noninvasive bladder cancer. However, serious systemic side effects may occur in less than 5% of patients with BCG intravesical instillation. Systemic side effects can sometimes be fatal and require early and accurate treatment. We describe five cases wherein steroid pulse therapy was effective for treating the systemic side effects after BCG intravesical instillation. . BCG intravesical instillation was used to prevent the recurrence of nonmuscle invasive bladder cancer and treat CIS of the bladder; the dose used was 40-80 mg each time, and the Tokyo strain was used. The patients developed fever, impaired consciousness, arthralgia, conjunctival hyperemia, and symptoms of cystitis. The median time from installation to side effect manifestation was 6 days (0-8). One to two courses of steroid pulse therapy were administered (1 course in 3 days), and the dose of methylprednisolone was 500-1000 mg/day. BCG sepsis was observed in one case; however, in the other four cases, one course of steroid pulse therapy showed a rapid improvement in symptoms. In the case of BCG sepsis, hemodialysis and mechanical ventilation were required because of septic shock and acute renal failure. Antituberculosis drugs (isoniazid, rifampicin, and ethambutol) were started promptly; however, no improvement was noticed. Two courses of steroid pulse therapy improved the patient's general condition, and hemodialysis and mechanical ventilation were no longer required. All patients survived without relapse of symptoms.
Our cases suggest that early steroid pulse therapy may be effective for rapid symptom improvement of the systemic side effects of BCG instillation therapy.
卡介苗（BCG）膀胱灌注是治疗膀胱原位癌（CIS）以及预防经尿道膀胱肿瘤电切术后非肌层浸润性膀胱癌复发的一种既定疗法。然而，接受BCG膀胱内灌注的患者中，不到5%可能会出现严重的全身副作用。全身副作用有时可能致命，需要早期准确的治疗。我们描述了5例使用类固醇冲击疗法有效治疗BCG膀胱内灌注后全身副作用的病例。BCG膀胱内灌注用于预防非肌层浸润性膀胱癌复发和治疗膀胱CIS；每次使用剂量为40 - 80毫克，使用东京菌株。患者出现发热、意识障碍、关节痛、结膜充血和膀胱炎症状。从灌注到副作用出现的中位时间为6天（0 - 8天）。给予1 - 2个疗程的类固醇冲击疗法（3天为1个疗程），甲泼尼龙剂量为500 - 1000毫克/天。1例观察到BCG败血症；然而，在其他4例中，1个疗程的类固醇冲击疗法使症状迅速改善。在BCG败血症病例中，由于感染性休克和急性肾衰竭，需要进行血液透析和机械通气。立即开始使用抗结核药物（异烟肼、利福平、乙胺丁醇）；然而，未见改善。2个疗程的类固醇冲击疗法改善了患者的一般状况，不再需要血液透析和机械通气。所有患者均存活，症状未复发。
我们的病例表明，早期类固醇冲击疗法可能对快速改善BCG灌注疗法的全身副作用症状有效。
