Proctor D D, Chopra S, Rubenstein S C, Jokela J A, Uhl L
Department of Medicine, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts.
Am J Gastroenterol. 1993 Jul;88(7):1112-5.
We describe the first case of mycobacteremia and granulomatous hepatitis occurring after the initial intravesical instillation of bacillus Calmette-Guerin (BCG) for bladder cancer. Eight days after BCG instillation, a liver biopsy revealed well-defined granulomas and acid-fast bacilli. A blood culture drawn 8 h after BCG instillation grew Mycobacterium bovis. We summarize the reported complications of BCG intravesical immunotherapy, the associated risk factors, and discuss options for treatment. Although rare, mycobacteremia and granulomatous hepatitis are important systemic side effects of intravesical instillation of BCG for bladder cancer, and should be considered in any patient who presents with persistent fever and abnormal liver function tests after instillation of BCG.
我们描述了首例膀胱癌患者在首次膀胱内灌注卡介苗（BCG）后发生分枝杆菌血症和肉芽肿性肝炎的病例。BCG灌注8天后，肝脏活检显示有边界清晰的肉芽肿和抗酸杆菌。BCG灌注8小时后采集的血培养物中培养出牛分枝杆菌。我们总结了已报道的BCG膀胱内免疫疗法的并发症、相关危险因素，并讨论了治疗方案。尽管罕见，但分枝杆菌血症和肉芽肿性肝炎是膀胱癌患者膀胱内灌注BCG重要的全身副作用，对于任何在BCG灌注后出现持续发热和肝功能检查异常的患者都应予以考虑。
