Disseminated M.bovis infection following intravesical BCG instillation for bladder carcinoma

  • Intravesical BCG instillation is first line in superficial bladder carcinoma.
  • It has been shown to delay the time to the first recurrence after transurethral resection of the bladder tumor and to reduce the risk of progression to muscle invasive disease.
  • Mechanism is unclear, probably related to local immune responses.
  • A rare adv effect is disseminated M.bovis infection.
  • Radiographically, present as GGO.
  • Histopathologically, granulomas are uniformly present in all forms of disseminated BCG disease, usually a caseating one.
  • Culture takes time but normally culturing the involved tissues will yield positive result.
  • Suggested treatment approach:
    Treat symptomatically if the symptoms are mild or <2 days.
    Pyrazinamide is NOT recommended due to resistance. Otherwise, treatment resembles that of TB treatment
    – M.bovis can cause hypersens.pneumonitis. A corticosteroid course can be added in severe disease.

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Reference:

Josalyn L. Cho, M.D., Shaunagh McDermott, M.D., Athe M. Tsibris, M.D.,
and Eugene J. Mark, M.D. Case 37-2015: A 76-Year-Old Man with Fevers, Leukopenia, and Pulmonary Infiltrates. N Engl J Med 2015;373:2162-72

Krisztina A. Nadasy, MD; Rikin S. Patel, MD; Michael Emmett, MD, MACP; Ricardo A. Murillo, MD; Marc A. Tribble, MD; Robert D. Black, MD; William L. Sutker, MD. Four Cases of Disseminated Mycobacterium bovis Infection Following Intravesical BCG Instillation for Treatment of Bladder Carcinoma. South Med J. 2008;101(1):91-95.

 

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