Salif Ayemane, Bigirimana Ferdinand, Willems Sophie, Reichman Gina, Noels Johanna, Wijngaert Sigi Van Den, Lecomte Sophie, Maillart Evelyne, Clevenbergh Philippe
Department of Surgery, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium.
Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium.
IDCases. 2024 Apr 19;36:e01967. doi: 10.1016/j.idcr.2024.e01967. eCollection 2024.
The Bacillus Calmette-Guérin (BCG) used as anti-tuberculous vaccine is also a well-known therapy for superficial urothelial cancer. Local or general side effects can occur, although it is generally well tolerated.
We present the case of a 65 year-old caucasian man consulting for gross hematuria and lower urinary tract symptoms. Magnetic resonance imaging (MRI) demonstrated a non-invasive urothelial carcinoma (NMIBC) and Prostate Imaging-Reporting and Data System (PIRADS) IV lesions. Transurethral resection of the bladder tumor revealed a non-invasive transitional cell carcinoma. Intravesical Bacillus Calmette Guerin (BCG) therapy was provided. After 6 intravesical instillations, the patient presented with prostato-epididymitis. Forthcoming BCG instillations were canceled, and cancer treatment was switched to epirubicine. Treatment with ethambutol, rifampicin and isoniazid was started with rapid resolution of the symptoms. Urinary and semen cultures grew complex strain BCG. As prostate specific antigen (PSA) rose, prostate's biopsies were performed showing extensive necrosis boarded by granulomas without signs of malignancy.
BCGitis is a rare complication in patients treated for non-invasive urothelial cancer. Several risk factors, local and systemic, should be considered prior to this immunotherapy. BCGitis (local or disseminated) or hypersensitivity reactions to BCG must be included in the differential diagnosis even if therapy was administered several years before the symptoms. Adequate treatment must be started as fast as possible to avoid serious complications.
用作抗结核疫苗的卡介苗（BCG）也是一种治疗浅表性尿路上皮癌的知名疗法。尽管通常耐受性良好，但仍可能出现局部或全身副作用。
我们报告一例65岁的白种男性患者，因肉眼血尿和下尿路症状前来就诊。磁共振成像（MRI）显示为非侵袭性尿路上皮癌（NMIBC）及前列腺影像报告和数据系统（PIRADS）IV级病变。经尿道膀胱肿瘤切除术显示为非侵袭性移行细胞癌。给予膀胱内卡介苗（BCG）治疗。在进行6次膀胱内灌注后，患者出现前列腺附睾炎。随后的BCG灌注被取消，癌症治疗改为表柔比星。开始使用乙胺丁醇、利福平及异烟肼治疗，症状迅速缓解。尿液和精液培养均检出复合型卡介苗菌株。随着前列腺特异性抗原（PSA）升高，进行了前列腺活检，结果显示广泛坏死，周围有肉芽肿，无恶性迹象。
卡介苗炎是接受非侵袭性尿路上皮癌治疗患者的一种罕见并发症。在进行这种免疫治疗之前，应考虑多种局部和全身的危险因素。即使在症状出现前数年已进行过治疗，在鉴别诊断中也必须考虑卡介苗炎（局部或播散性）或对BCG的超敏反应。必须尽快开始适当治疗以避免严重并发症。
