Kurokawa Yoshiaki, Kawai Taketo, Miyakawa Jimpei, Makise Naohiro, Akiyama Yoshiyuki, Yamada Yuta, Sato Yusuke, Yamada Daisuke, Ushiku Tetsuo, Kume Haruki
Departments of Urology Graduate School of Medicine The University of Tokyo Tokyo Japan.
Department of Pathology Graduate School of Medicine The University of Tokyo Tokyo Japan.
IJU Case Rep. 2021 Oct 3;5(1):45-47. doi: 10.1002/iju5.12385. eCollection 2022 Jan.
Intravesical Bacillus Calmette-Guerin immunotherapy is known to prevent recurrence of bladder cancer, but it can cause tuberculosis infections as an adverse event.
A 75-year-old man visited our hospital due to hematuria. The patient was diagnosed with bladder cancer and underwent transurethral resection of the bladder tumor. Postoperatively, the patient received Bacillus Calmette-Guerin immunotherapy. One year later, we performed transurethral surgery and prostate biopsy because of cystoscopic findings showing nodulous lesions in the bladder and an elevated serum prostate-specific antigen level. The patient presented with high fever and malaise since the surgery. After careful examination, the patient was diagnosed with miliary tuberculosis caused by . The pathology of the bladder and prostate revealed acid-fast bacilli collection by Ziehl-Neelsen staining.
The surgery exacerbated the local infection into a systemic infection. The risk of developing miliary tuberculosis should be considered at transurethral surgery or prostate biopsy in patients after intravesical Bacillus Calmette-Guerin immunotherapy.
膀胱内卡介苗免疫疗法已知可预防膀胱癌复发，但它可导致结核感染作为一种不良事件。
一名75岁男性因血尿前来我院就诊。该患者被诊断为膀胱癌并接受了膀胱肿瘤经尿道切除术。术后，患者接受了卡介苗免疫疗法。一年后，由于膀胱镜检查发现膀胱内有结节性病变且血清前列腺特异性抗原水平升高，我们进行了经尿道手术和前列腺活检。自手术后，患者出现高热和不适。经过仔细检查，患者被诊断为由……引起的粟粒性结核。膀胱和前列腺的病理检查通过萋-尼染色显示有抗酸杆菌聚集。
手术将局部感染加重为全身感染。对于接受膀胱内卡介苗免疫疗法后的患者，在进行经尿道手术或前列腺活检时应考虑发生粟粒性结核的风险。
