Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Department of Gastroenterology, Sismanoglio General Hospital, Athens, Greece.
Am J Case Rep. 2021 Oct 16;22:e933006. doi: 10.12659/AJCR.933006.
BACKGROUND Bladder cancer (BC) is the second most common cancer involving the urinary system. In non-muscle-invading BC, transurethral resection of a bladder tumor followed by intravesical immunotherapy with Bacillus Calmette-Guerin (BCG) is the usual treatment. Disseminated (or systemic) BCG infection (BCGitis) represents the most severe adverse effect of intravesical BCG therapy, presenting with high-grade fever, with or without symptoms in the urinary tract, leading to severe sepsis and death if left untreated. The treatment of choice consists of isoniazid, rifampicin, and ethambutol (with or without corticosteroids) for 6 months, and the recovery rate is extremely high. Given the fact that these drugs are hepatotoxic, treating a patient with liver cirrhosis is challenging. CASE REPORT We present a patient with a medical history of BC treated with transurethral resection and intravesical BCG therapy, presenting with fever, transaminasemia, and generalized weakness. Liver and bone marrow biopsies revealed liver cirrhosis and granulomas in both organs. A diagnose of BCGitis was made and the patient was treated with isoniazid, rifampicin, and ethambutol; rifampicin was substituted with moxifloxacin after 1 month due to worsening of liver laboratory results, and moxifloxacin was substituted with levofloxacin later on due to tonic-clonic seizures. The patient was treated for 4 more months with levofloxacin and for 7 more months with isoniazid and ethambutol, with no other adverse effects, preserving liver function and achieving cure of BCGitis. CONCLUSIONS We present the case of a cirrhotic patient presenting with fever and deterioration of liver laboratory results, found to have BCGitis, and discuss possible difficulties in diagnosing and treating such patients.
膀胱癌（BC）是泌尿系统中第二大常见的癌症。在非肌肉浸润性 BC 中，经尿道膀胱肿瘤切除术联合卡介苗（BCG）膀胱内免疫治疗是常用的治疗方法。播散性（或系统性）BCG 感染（BCG 炎）是膀胱内 BCG 治疗最严重的不良反应，表现为高热，伴有或不伴有尿路症状，如不治疗可导致严重败血症和死亡。治疗选择包括异烟肼、利福平、乙胺丁醇（加或不加皮质类固醇）6 个月，且治愈率极高。鉴于这些药物具有肝毒性，治疗肝硬化患者具有挑战性。
我们介绍了一位有 BC 经尿道切除术和膀胱内 BCG 治疗病史的患者，表现为发热、肝转氨酶升高和全身无力。肝脏和骨髓活检显示肝硬化和两个器官的肉芽肿。诊断为 BCG 炎，给予异烟肼、利福平、乙胺丁醇治疗；由于肝功能检查结果恶化，1 个月后用莫西沙星替代利福平，后来因强直阵挛性发作改用左氧氟沙星。患者继续用左氧氟沙星治疗 4 个月，用异烟肼和乙胺丁醇治疗 7 个月，无其他不良反应，肝功能正常，BCG 炎治愈。
我们报告了一例肝硬化患者出现发热和肝功能检查结果恶化，被诊断为 BCG 炎，并讨论了诊断和治疗此类患者可能存在的困难。
