Mitra Debdeep, Bhatnagar Anuj, Suhag Devinder, Sandhu Sunmeet
Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India.
Indian Dermatol Online J. 2021 Aug 2;12(5):745-749. doi: 10.4103/idoj.IDOJ_158_21. eCollection 2021 Sep-Oct.
Primary Bacillus Calmette-Guérin (BCG) infection of the glans penis is not a very common entity and has been rarely reported in literature. BCG has been used as an adjuvant therapy in patients of transitional cell urinary bladder carcinoma following transurethral resection of bladder tumor. We report a 66-year-old male patient who was being managed for urinary bladder carcinoma with nine sittings of adjuvant BCG therapy. He developed painless swelling with multiple pustules over glans penis and prepuce along with inguinal lymphadenopathy. He had a BCG inoculation scar over his arm and his chest X-ray was within normal limits. His workup for sexually transmitted disease was negative. The biopsy from the nodule on prepuce revealed mixed inflammatory infiltrate comprising of neutrophils, lymphocytes, and eosinophils along with numerous congested blood vessels and hemosiderin macrophages. Mycobacterium tuberculosis gene expert from tissue was positive for acid fast bacilli (AFB). Fine-needle aspiration cytology from the right inguinal lymph node also revealed AFB on Ziehl-Neelsen stain. The BCG immunotherapy was stopped and the patient was started on a standard four-drug antitubercular therapy comprising isoniazid, rifampicin, ethambutol, and pyrazinamide along with daily doses of pyridoxine. The edema resolved and papules subsided within 2 weeks after starting antitubercular therapy. This is a very rare presentation although intravesical BCG therapy is a very common treatment modality, hence this report is intended to increase awareness of this condition in dermatologists and venereologists.
阴茎头原发性卡介苗（BCG）感染并非常见病症，文献中鲜有报道。卡介苗已被用作经尿道膀胱肿瘤切除术后移行细胞膀胱癌患者的辅助治疗。我们报告一名66岁男性患者，因膀胱癌接受了9次卡介苗辅助治疗。他出现阴茎头和包皮无痛性肿胀，伴有多个脓疱，同时伴有腹股沟淋巴结病。他手臂上有卡介苗接种疤痕，胸部X线检查正常。他的性传播疾病检查结果为阴性。包皮结节活检显示有混合性炎症浸润，包括中性粒细胞、淋巴细胞和嗜酸性粒细胞，以及大量充血血管和含铁血黄素巨噬细胞。组织的结核分枝杆菌基因专家检测显示抗酸杆菌（AFB）呈阳性。右侧腹股沟淋巴结细针穿刺细胞学检查在齐-尼氏染色下也显示有抗酸杆菌。卡介苗免疫治疗停止，患者开始接受标准的四联抗结核治疗，包括异烟肼、利福平、乙胺丁醇和吡嗪酰胺，同时每日服用吡哆醇。开始抗结核治疗后2周内水肿消退，丘疹消退。尽管膀胱内卡介苗治疗是一种非常常见的治疗方式，但这种表现非常罕见，因此本报告旨在提高皮肤科医生和性病科医生对这种情况的认识。
