[BCG infection of the glans penis after intravesical BCG therapy]

A Rare Case Report of BCG Induced Balanitis in a Patient with Transitional Cell Carcinoma of Urinary Bladder

Primary Bacillus Calmette-Guérin (BCG) infection of the glans penis is not a very common entity and has been rarely reported in literature. BCG has been used as an adjuvant therapy in patients of transitional cell urinary bladder carcinoma following transurethral resection of bladder tumor. We report a 66-year-old male patient who was being managed for urinary bladder carcinoma with nine sittings of adjuvant BCG therapy. He developed painless swelling with multiple pustules over glans penis and prepuce along with inguinal lymphadenopathy. He had a BCG inoculation scar over his arm and his chest X-ray was within normal limits. His workup for sexually transmitted disease was negative. The biopsy from the nodule on prepuce revealed mixed inflammatory infiltrate comprising of neutrophils, lymphocytes, and eosinophils along with numerous congested blood vessels and hemosiderin macrophages. Mycobacterium tuberculosis gene expert from tissue was positive for acid fast bacilli (AFB). Fine-needle aspiration cytology from the right inguinal lymph node also revealed AFB on Ziehl-Neelsen stain. The BCG immunotherapy was stopped and the patient was started on a standard four-drug antitubercular therapy comprising isoniazid, rifampicin, ethambutol, and pyrazinamide along with daily doses of pyridoxine. The edema resolved and papules subsided within 2 weeks after starting antitubercular therapy. This is a very rare presentation although intravesical BCG therapy is a very common treatment modality, hence this report is intended to increase awareness of this condition in dermatologists and venereologists.

Bacillus Calmette-Guérin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: incidence, risk factors, and outcome in a single-institution series and review of the literature

Bacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0-9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p < 0.001 for all comparisons). Attributable mortality was higher for patients aged ≥65 years (7.4% vs 2.1%; p = 0.091) and those with disseminated infection (9.9% vs 3.0%; p = 0.040) and vascular involvement (16.7% vs 4.6%; p = 0.064). The scheduled BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy.

Complications of intravesical bacillus calmette-guérin

Intravesical Bacillus Calmette-Guérin (BCG) is an important treatment for the management of non-muscle invasive bladder cancer because of its proven efficacy and favourable safety profile. The most common complications associated with BCG treatment are relatively minor. They include urinary frequency, cystitis, fever, and hematuria. Although serious complications are rare, patients can develop severe, life-threatening sepsis with disseminated mycobacterial infection. We report a rare case of periurethral diverticulum formation after intravesical BCG and review the literature on the potential complications of this treatment modality.