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The Journal of the Royal College of... Jun 2020Intra-vesical Bacillus Calmette-Guérin (BCG) immunotherapy is an effective treatment for high-risk bladder cancer. Less well known is that fewer than 1% of patients...
Intra-vesical Bacillus Calmette-Guérin (BCG) immunotherapy is an effective treatment for high-risk bladder cancer. Less well known is that fewer than 1% of patients receiving BCG treatment can develop disseminated BCG. The reaction can range from a mild flu-like illness to a systemic disorder with a fulminant course which in the most severe cases can lead to death. The diagnostic yield is low and diagnosis is often made after a comprehensive exclusion of more common causes of pyrexia of unknown origin. A high level of suspicion is therefore required in those who may be at risk. We report a case of disseminated BCG in an older patient for whom early involvement of his family was pertinent to determining the precipitant for delirium.
Topics: Aged; BCG Vaccine; Bacillus; Delirium; Humans; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 32568287
DOI: 10.4997/JRCPE.2020.215 -
Journal of Community Hospital Internal... May 2020Intravesical instillation of Bacillus-Calmette-Guerin (BCG), a live-attenuated-strain of , is an established treatment for superficial bladder carcinoma. Although...
Intravesical instillation of Bacillus-Calmette-Guerin (BCG), a live-attenuated-strain of , is an established treatment for superficial bladder carcinoma. Although generally well tolerated, 1/15,000 patients can develop life-threatening disseminated-BCG-infection typically soon after the procedure, a condition colloquially termed BCG-osis. Side-effects of intravesical BCG instillation including fever, chills, fatigue are common but BCG-osis is rare and severe, oftentimes requiring intensive care unit admission and triple anti-TB-therapy as in this case. It is therefore important for clinicians to recognize this possibility as the absence of specific signs and symptoms, coupled with the fastidious nature of the Mycobacteria, pose a diagnostic dilemma in the acute setting. Our case highlights this potential rare iatrogenic side effect of intravesical BCG treatment and the risk associated with non-treatment of BCG-osis.
PubMed: 32850058
DOI: 10.1080/20009666.2020.1742475 -
International Journal of Infectious... Nov 2009The bacille Calmette-Guérin (BCG) vaccine is a widely practiced vaccine, which is useful for prophylaxis against tuberculosis. Disseminated BCG infection (BCG-osis) is...
BACKGROUND
The bacille Calmette-Guérin (BCG) vaccine is a widely practiced vaccine, which is useful for prophylaxis against tuberculosis. Disseminated BCG infection (BCG-osis) is one of the most important complications of this vaccine and can be seen in patients with an underlying immunodeficiency. This study was performed to determine the underlying defects in patients with BCG-osis.
METHODS
Immunological evaluation was performed in all children who developed BCG-osis after vaccination in Tabriz, Iran.
RESULTS
BCG-osis was documented in eight patients following vaccination. Axillary adenitis was detected in seven patients, and hepatosplenomegaly was also found in seven patients. Immunological studies revealed low serum IgG, IgM and IgA levels in all patients. Further investigations for enumeration of the lymphocyte sub-population revealed severe combined immunodeficiency (SCID) in all the patients. Three patients had T-B+NK- SCID, four had T-B-NK+ SCID, and one had T-B+NK+ SCID. Unfortunately, all the patients died due to the severe disseminated BCG infection.
CONCLUSIONS
Inoculation of live vaccines such as BCG should be postponed for a few months in suspected cases of primary immunodeficiency disease, until appropriate screening tests exclude this diagnosis; vaccination should then be performed in those with an intact immune system.
Topics: BCG Vaccine; Female; Humans; Infant; Iran; Male; Mycobacterium bovis; Severe Combined Immunodeficiency; Tuberculosis; Vaccination
PubMed: 19403320
DOI: 10.1016/j.ijid.2009.02.008 -
Case Reports in Urology 2013Intravesical Bacilli Calmette-Guérin (BCG) immunotherapy is a commonly used treatment for superficial bladder cancer. Although the treatment is well tolerated in 95% of...
Intravesical Bacilli Calmette-Guérin (BCG) immunotherapy is a commonly used treatment for superficial bladder cancer. Although the treatment is well tolerated in 95% of cases, life-threatening side effects including BCG sepsis can occur. This report describes the case of an 82-year-old man with a background of lung disease. He developed septic shock and type two respiratory failure after receiving the sixth installation of intravesical BCG (TICE strain) immunotherapy for recurrent bladder Transitional Cell Carcinoma in situ. Despite the early initiation of broad spectrum antibiotics (tazocin and gentamicin), he remained pyrexial. There was a rapid deterioration, and on the second day of his admission, he developed type two respiratory failure secondary to Acute Respiratory Distress Syndrome (ARDS) prompting transfer to Intensive Care for Bilevel Positive Airway Pressure (BiPAP) Ventilation. The blood cultures taken before the induction of antibiotics results were negative. Increasing clinical suspicion of systemic BCG-osis prompted the initiation of antituberculosis therapy (ethambutol, isoniazid rifampicin) and steroids. Following six days of BiPAP and anti-tuberculosis therapy in ITU, his condition started to improve. Following a prolonged hospital stay he was discharged on long term ethambutol therapy. BCG-osis is a well-known though rare side effect of intravesical BCG therapy. We would like to highlight the importance of having a low threshold for starting anti-TB treatment.
PubMed: 23844314
DOI: 10.1155/2013/821526 -
BMJ Case Reports Jul 2016A 69-year-old male patient who was treated with intravesical BCG for carcinoma in situ of the bladder, went on to develop systemic features of BCG-osis. This diagnosis...
A 69-year-old male patient who was treated with intravesical BCG for carcinoma in situ of the bladder, went on to develop systemic features of BCG-osis. This diagnosis was supported by significant radiological and clinical findings. These systemic features include pulmonary miliary lesions, a mycotic abdominal aortic aneurysm and penile lesions. Owing to a breakdown in the relationship between the patient and the National Health Service, the patient has declined BCG treatment. This case highlights the potential rare side effects of intravesical BCG treatment and the risk associated with non-treatment of BCG-osis.
Topics: Administration, Intravesical; Aged; Aneurysm, Infected; Animals; Aortic Aneurysm, Abdominal; BCG Vaccine; Carcinoma in Situ; Cattle; Granuloma; Humans; Male; Multiple Pulmonary Nodules; Penile Diseases; Tuberculosis, Bovine; Tuberculosis, Miliary; Urinary Bladder Neoplasms
PubMed: 27417990
DOI: 10.1136/bcr-2016-215635 -
Journal of Medical Case Reports Jan 2024Intravesical Bacillus Calmette-Guérin (BCG) is used as a standard adjuvant therapy for non-muscle invasive urothelial cancer. Most patients tolerate the treatment...
BACKGROUND
Intravesical Bacillus Calmette-Guérin (BCG) is used as a standard adjuvant therapy for non-muscle invasive urothelial cancer. Most patients tolerate the treatment well, with mild side effects. Systemic complications are extremely rare, occur due to BCG dissemination and are associated with immunocompromised state and urothelial breach.
CASE PRESENTATION
We present a case of a 78-year-old male, a former smoker, with history of non-muscle invasive urothelial carcinoma status post partial resection followed by intravesical BCG therapy. An autopsy was performed due to the sudden nature of his death. Autopsy showed multiple necrotizing granulomas in the brain, atrium, ventricles, lungs, kidneys, and urinary bladder. Stains for acid-fast bacilli and fungi were negative. In addition, bilateral lungs showed evidence of bronchopneumonia secondary to cytomegalovirus.
CONCLUSION
Granulomatous myocarditis arising from BCG therapy is extremely rare. Our patient with urothelial cancer treated with BCG developed multiorgan granulomas, most likely due to a hypersensitivity reaction to intravesical BCG. Arrhythmia induced by granulomatous myocarditis was the cause of his death. Although there have been few cases of systemic BCG-osis causing fatal sepsis leading to death, a cardiac cause of death is unique.
Topics: Aged; Humans; Male; Autopsy; BCG Vaccine; Carcinoma, Transitional Cell; Granuloma; Myocarditis; Urinary Bladder Neoplasms; Fatal Outcome
PubMed: 38195538
DOI: 10.1186/s13256-023-04310-4 -
MMWR. Morbidity and Mortality Weekly... Aug 2014Poliovirus transmission has been eliminated in most of the world through the use of inactivated poliovirus vaccine (IPV) and live, attenuated oral poliovirus vaccine...
Poliovirus transmission has been eliminated in most of the world through the use of inactivated poliovirus vaccine (IPV) and live, attenuated oral poliovirus vaccine (OPV). In the United States, use of OPV was discontinued by the year 2000 because of the potential for vaccine-associated paralytic polio (VAPP); an average of eight cases were reported each year in the United States during 1980-2000. Polio eradication efforts in other parts of the world continue to rely on OPV to take advantage of transmission of poliovirus vaccine strains to unvaccinated persons in the population, lower cost, and ease of administration. In 2013, an infant aged 7 months who recently immigrated to the United States from India was referred to a hospital in San Antonio, Texas. The infant had fever, an enlarging skin lesion in the deltoid region with axillary lymphadenopathy, decreased activity, and inability to bear weight on the left leg, progressing to paralysis of the left leg over a 6-week period. Recognition of lymphopenia on complete blood count led to immune evaluation, which revealed the presence of severe combined immunodeficiency syndrome (SCIDS), an inherited disorder. A history of OPV and bacille Calmette-Guérin (BCG) vaccination in India led to the diagnoses of VAPP and BCG-osis, which were confirmed microbiologically. This report demonstrates the importance of obtaining a comprehensive clinical history in a child who has recently immigrated to the United States, with recognition that differing vaccine practices in other countries might require additional consideration of potential etiologies.
Topics: BCG Vaccine; Emigrants and Immigrants; Fatal Outcome; Humans; India; Infant; Male; Paralysis; Poliomyelitis; Poliovirus Vaccine, Oral; Severe Combined Immunodeficiency; Texas; Tuberculosis; Vaccines, Attenuated
PubMed: 25144542
DOI: No ID Found -
The Brazilian Journal of Infectious... 2011Bacillus Calmette Guerin (BCG) vaccine, which is administered to all newborns in some regions, could lead to serious complication ranging from local disease (known as...
Bacillus Calmette Guerin (BCG) vaccine, which is administered to all newborns in some regions, could lead to serious complication ranging from local disease (known as BCGitis) to disseminated disease (BCGosis) in a group of patients with primary immunodeficiency diseases. We are reporting here a 3.5 year-old girl with a history of prolonged BCGitis, which developed to disseminated disease without any other special features. Immunological studies with nitro-blue tetrazolium test confirmed the diagnosis of chronic granulomatous disease in this patient. Chronic granulomatous disease should be considered in the list of differential diagnosis in all children with BCGosis, even in the absence of any other manifestations related to immunodeficiency.
Topics: Adjuvants, Immunologic; BCG Vaccine; Child, Preschool; Diagnosis, Differential; Female; Granulomatous Disease, Chronic; Humans
PubMed: 21412596
DOI: 10.1016/s1413-8670(11)70146-5 -
BMJ Case Reports Dec 2019A 79-year-old man presented with an enlarging thoracic aneurysm on the background of superficial bladder cancer treated with intravesical bacillus Calmette-Guérin (BCG)...
A 79-year-old man presented with an enlarging thoracic aneurysm on the background of superficial bladder cancer treated with intravesical bacillus Calmette-Guérin (BCG) injections. Following the injections, he developed deranged liver function tests and hepatomegaly. Liver biopsy revealed granulomatous hepatitis compatible with disseminated mycobacterial infection (BCG-osis) and was treated with anti-tuberculosis agents for 12 months. A surveillance CT scan performed as a follow-up for his bladder cancer in 2018 revealed a saccular thoracic aneurysm at the ligamentum arteriosum, which was metabolically active on positron emission tomography (PET) scan. Given the timeframe from intravesical instillation of BCG and the metabolic activity on PET scan, the lesion was consistent with a mycotic aneurysm secondary to disseminated mycobacterial infection. Following multidisciplinary team discussion, a thoracic endovascular aneurysm repair was performed. The stent grafts were placed distal to the left subclavian artery with good angiographic results and no immediate postoperative complications. He was initiated on long-term antibiotics to cover potential bacterial pathogens including mycobacterium.
Topics: Adjuvants, Immunologic; Aged; Animals; Anti-Bacterial Agents; Antitubercular Agents; Aorta, Thoracic; Aortic Aneurysm, Abdominal; BCG Vaccine; Humans; Male; Mycobacterium Infections; Positron Emission Tomography Computed Tomography; Urinary Bladder Neoplasms
PubMed: 31843771
DOI: 10.1136/bcr-2019-231595 -
Clinical & Developmental Immunology 2011IFN-γ has been used in the treatment of IL-12Rβ1 deficiency patients with disseminated BCG infection (BCGosis), but the optimal dose to reach efficacy is not clear. We...
IFN-γ has been used in the treatment of IL-12Rβ1 deficiency patients with disseminated BCG infection (BCGosis), but the optimal dose to reach efficacy is not clear. We used IFN-γ in the treatment of a 2.7-year-old patient with IL-12Rβ1 deficiency and refractory BCG-osis. IFNγ was started at a dose of 50 μg/m² 3 times per week. The dose was upgraded to 100 mcg/m² after 3 months, then to 200 mcg/m² 6 months afterwards. Serum mycobactericidal activity and lymphocytes number and function were evaluated throughout the study. There was no clinical response to IFN-γ with 50 or 100 μg/m² doses. However, there was some response to the 200 μg/m² dose with no additional adverse effects. The serum mycobactericidal activity was not significantly different during the whole treatment period. Lymphocytes proliferation in response to PHA was significantly higher after 3 months of using the highest dose as compared to the lowest dose. The tuberculin skin test reaction remained persistently negative. We conclude that in a patient with IL-12Rβ1 deficiency, IFN-γ at a dose of 200 μg/m², but not at lower dosages, was found to have a noticeable clinical effect with no additional adverse effects.
Topics: BCG Vaccine; Child, Preschool; Female; Humans; Interferon-gamma; Lymphocyte Activation; Mycobacterium Infections; Mycobacterium bovis; Receptors, Interleukin-12; Treatment Outcome
PubMed: 21234109
DOI: 10.1155/2011/691956