Uematsu Riku, Teishima Jun, Sakata Hiroyuki, Mita Yoshie, Yoshii Takahiko, Tashiro Yuki, Yao Akihisa, Nakamura Ichiro
Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan.
Int Cancer Conf J. 2023 Apr 1;12(3):221-225. doi: 10.1007/s13691-023-00602-0. eCollection 2023 Jul.
We report a rare case of peritoneal and pulmonary tuberculosis after intravesical instillation of Bacillus Calmette-Guérin (BCG). A 76-year-old man diagnosed as high-grade urothelial carcinoma (UC) with carcinoma in situ (CIS) was treated with intravesical BCG instillation and transurethral resection of bladder tumor (TUR-BT). Three months later, TUR-BT for recurrent tumors and multiple site biopsy of bladder mucosa were performed. During TUR-BT, near perforation in the posterior wall was observed, and was disappeared after observation with urethral catheterization for 1 week. Two weeks later, he was admitted with a complaint of abdominal distention, and a computed tomography (CT) showed ascites. One week later, CT showed pleural effusion and worsening of ascites. Drainage of pleural effusion and ascites puncture was performed, and elevated adenosine deaminase (ADA) and lymphocytes count were subsequently found. In laparoscopic examination, numerous white nodules were observed in the peritoneum and omentum, and Langhans giant cells were pathologically identified in biopsy specimens. Mycobacterium culture confirmed complex. The patient was then diagnosed with pulmonary and peritoneal tuberculosis. Anti-tuberculous agents consisting of isoniazid (INH), rifampicin (RFP), and ethambutol (EB) were administered. Six months later, a CT scan showed no evidence of pleural effusion or ascites. There has been no recurrence of either urothelial cancer or tuberculosis during follow-up for 2 years.
我们报告一例卡介苗（BCG）膀胱内灌注后发生腹膜和肺结核的罕见病例。一名76岁男性被诊断为高级别尿路上皮癌（UC）伴原位癌（CIS），接受了卡介苗膀胱内灌注和经尿道膀胱肿瘤切除术（TUR - BT）治疗。三个月后，因肿瘤复发进行了TUR - BT及膀胱黏膜多处活检。在TUR - BT过程中，观察到膀胱后壁接近穿孔，留置尿道导管观察1周后穿孔消失。两周后，患者因腹胀入院，计算机断层扫描（CT）显示有腹水。一周后，CT显示胸腔积液且腹水加重。进行了胸腔积液引流和腹水穿刺，随后发现腺苷脱氨酶（ADA）升高及淋巴细胞计数增加。在腹腔镜检查中，在腹膜和大网膜观察到大量白色结节，活检标本经病理鉴定发现朗汉斯巨细胞。分枝杆菌培养证实为复合菌。该患者随后被诊断为肺和腹膜结核。给予异烟肼（INH）、利福平（RFP）和乙胺丁醇（EB）组成的抗结核药物治疗。六个月后，CT扫描显示无胸腔积液或腹水迹象。在2年的随访期间，尿路上皮癌和结核均未复发。
