King Brianna, Singh Dhanveer, Rathore Animesh, Flenner Ronald, Flemmer Mark
Eastern Virginia Medical School, Norfolk, VA 23507, USA.
Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
J Clin Med. 2022 Oct 21;11(20):6226. doi: 10.3390/jcm11206226.
(1) Background: Intravesical instillation of therapeutic Bacillus Calmette-Guerin (BCG) is the standard of treatment for non-muscular invasive bladder cancer. Although the exact immunomodulatory effects of BCG therapy in non-muscular invasive bladder cancer (NMIBC) are still unclear, it has been considered a safe and effective treatment with the largest to-date report of complications citing minimal side effects, none of which included arterial involvement; (2) Methods: A systematic literature review was performed using PubMed, Cochrane, Medline, and Google Scholar from database inception to March 2021. Only eligible studies reporting aneurysm formation in adult patients with a history of BCG immunotherapy and no previous vascular pathology were included; (3) Results: A systematic literature review was conducted, highlighting 17 reports suggestive of BCG-induced mycotic aneurysm development. We added a case of a 78-year-old male, 30 months after last BCG-instillation, with a mycotic abdominal aneurysm yielding with pyrazinamide resistance culture.; (4) Conclusions: Concluding results suggest a higher incidence of vascular complications from BCG intravesical therapy in the treatment of non-muscular invasive bladder cancer than previously reported. Recommendations are made to emphasize further research of this immunotherapy complication to facilitate the creation of guidelines for diagnosis and management of these patients.
(1) 背景：膀胱内灌注治疗性卡介苗（BCG）是非肌层浸润性膀胱癌的标准治疗方法。尽管BCG治疗在非肌层浸润性膀胱癌（NMIBC）中的确切免疫调节作用仍不清楚，但它被认为是一种安全有效的治疗方法，迄今为止最大规模的并发症报告显示其副作用极小，且均未涉及动脉受累情况；(2) 方法：从数据库建立至2021年3月，使用PubMed、Cochrane、Medline和谷歌学术进行系统的文献综述。仅纳入报告了有BCG免疫治疗史且既往无血管病变的成年患者发生动脉瘤形成的合格研究；(3) 结果：进行了系统的文献综述，突出显示了17份提示BCG诱导霉菌性动脉瘤形成的报告。我们补充了1例78岁男性病例，在最后一次BCG灌注30个月后，出现了对吡嗪酰胺耐药培养结果的霉菌性腹主动脉瘤；(4) 结论：最终结果表明，非肌层浸润性膀胱癌治疗中BCG膀胱内治疗引起的血管并发症发生率高于先前报告。建议进一步研究这种免疫治疗并发症，以促进制定这些患者的诊断和管理指南。
