Schembri Higgans Jessica, Pace Keith, Sciberras John, Scicluna Warren
Department of Surgery, Mater Dei Hospital, Dun Karm Street, Msida MSD2090, Malta.
J Surg Case Rep. 2021 Dec 17;2021(12):rjab544. doi: 10.1093/jscr/rjab544. eCollection 2021 Dec.
Bacillus Calmette-Guerin (BCG) immunotherapy is a mainstay of adjunctive therapy for non-muscle-invasive bladder cancer. The instillation of BCG in the upper urinary tract after complete tumour eradication has also been studied and used after kidney-sparing management. It is effective in increasing the length of remission. However, it is also associated with rare but severe local and systemic side effects which may potentially become life-threatening. We present a case report of a 37-year-old gentleman who developed BCGosis following intra-renal instillation of BCG immunotherapy. The patient presented with systemic symptoms of jaundice, fever, myalgia and arthralgia, rather than local symptoms. infection was confirmed on blood cultures. The patient also developed hepatosplenomegaly, dyspnoea and pancytopaenia. BCGosis following intravesical instillation has been well documented in literature; to the best of our knowledge, this is the first case report documenting BCGosis following intra-renal instillation.
卡介苗（BCG）免疫疗法是非肌肉浸润性膀胱癌辅助治疗的主要手段。在肿瘤完全根除后，卡介苗在上尿路的灌注也已得到研究，并在保留肾单位的治疗后使用。它在延长缓解期方面有效。然而，它也与罕见但严重的局部和全身副作用相关，这些副作用可能会危及生命。我们报告一例37岁男性在肾内灌注卡介苗免疫治疗后发生卡介苗病的病例。患者表现为黄疸、发热、肌痛和关节痛等全身症状，而非局部症状。血培养证实有感染。患者还出现肝脾肿大、呼吸困难和全血细胞减少。膀胱内灌注后发生卡介苗病在文献中有充分记载；据我们所知，这是第一例记录肾内灌注后发生卡介苗病的病例报告。
