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Sakurai Y, Furuto Y, Saito T, Namikawa A, Takahashi H, Shibuya Y. Disseminated Bacillus Calmette-Guérin Infection with Rhabdomyolysis, Acute Kidney Injury, and Interstitial Pneumonia after Bacillus Calmette-Guérin Intravesical Instillation Therapy. Intern Med 2023; 62:3707-3712. [PMID: 37164678 PMCID: PMC10781554 DOI: 10.2169/internalmedicine.1413-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/21/2023] [Indexed: 05/12/2023] Open
Abstract
A 79-year-old man experienced a fever and immobility after receiving 6 doses of Bacillus Calmette-Guérin (BCG) intravesical instillation therapy for bladder tumor. Rhabdomyolysis and acute kidney injury occurred; therefore, hemodialysis was performed. His kidney function was restored. However, he exhibited an inflammatory reaction that was resistant to broad-spectrum antibiotics and eventually developed interstitial pneumonia. Corticosteroid treatment partially relieved the symptoms of interstitial pneumonia, although disuse syndrome persisted. He was diagnosed with disseminated BCG infection through sputum culture. BCG infection shows various symptoms and is difficult to diagnose microbiologically. It should be suspected when systemic symptoms occur after BCG intravesical instillation therapy.
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Affiliation(s)
- Yuki Sakurai
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Japan
| | - Yoshitaka Furuto
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Japan
| | - Takahiro Saito
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Japan
| | - Akio Namikawa
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Japan
| | - Hiroko Takahashi
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Japan
| | - Yuko Shibuya
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Japan
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Cui A, Li X, Ma X, Song Z, Wang X, Wang C, Xia Y. Quantitative transcriptomic and proteomic analysis reveals corosolic acid inhibiting bladder cancer via suppressing cell cycle and inducing mitophagy in vitro and in vivo. Toxicol Appl Pharmacol 2023; 480:116749. [PMID: 37939859 DOI: 10.1016/j.taap.2023.116749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/03/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
Corosolic acid (CA) is a plant-derived terpenoid compound with many health benefits. However, the anti-tumor effects of CA in bladder cancer remain unexplored. Here, we found that CA inhibited bladder tumor both in vitro and in vivo, and had no significant toxicity in mice. With the aid of transcriptomics and proteomics, we elucidated the regulatory network mechanism of CA inhibiting bladder cancer. Through cell viability detection, cell fluorescence staining and flow cytometry, we discovered that CA inhibited bladder cancer mainly through blocking cell cycle. Interestingly, CA played anticancer roles by distinct mechanisms at different concentrations: low concentrations (<7.0 μg/ml) of CA mainly inhibited DNA synthesis by downregulating TOP2A and LIG1, and diminished mitosis by downregulating CCNA2, CCNB1, CDC20, and RRM2; high concentrations (≥7.0 μg/ml) of CA induced cell death through triggering mitophagy via upregulating NBR1, TAXBP1, SQSTM1/P62, and UBB. CA, as a natural molecule of homology of medicine and food, is of great significance for the prevention and treatment of cancer patients following clarifying its anti-cancer mechanism. This study provides a comprehensive understanding of the pharmacological mechanism of CA inhibition in bladder cancer, which is helpful for the development of new anti-tumor drugs based on CA.
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Affiliation(s)
- Anfang Cui
- College of Basic Medicine, Jining Medical University, Jining, Shandong 272067, China
| | - Xiangling Li
- College of Basic Medicine, Jining Medical University, Jining, Shandong 272067, China
| | - Xiaolei Ma
- College of Basic Medicine, Jining Medical University, Jining, Shandong 272067, China
| | - Zhigang Song
- College of Basic Medicine, Jining Medical University, Jining, Shandong 272067, China
| | - Xiao Wang
- Precision Medicine Laboratory for Chronic Non-communicable Diseases of Shandong Province, Institute of Precision Medicine, Jining Medical University, Jining, Shandong 272067, China
| | - Chao Wang
- Department of Urology, Shandong First Medical University Affiliated Jining First People's Hospital, Jining 272106, China.
| | - Yong Xia
- Precision Medicine Laboratory for Chronic Non-communicable Diseases of Shandong Province, Institute of Precision Medicine, Jining Medical University, Jining, Shandong 272067, China.
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3
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Fernandes PF, Nunes P, Figueiredo A. Septic Shock After Intravesical Therapy With Bacillus Calmette-Guerin: A Case Report of a Rare Life-Threatening Complication. Cureus 2023; 15:e46563. [PMID: 37933342 PMCID: PMC10625662 DOI: 10.7759/cureus.46563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/08/2023] Open
Abstract
Intravesical therapy with Bacillus Calmette-Guerin (BCG) is the mainstay treatment for high-risk non-muscle invasive bladder cancer. The side effects are usually local and mild. Systemic dissemination of BCG is rare, typically develops soon after instillation, and may present as a severe life-threatening condition. We present a case of a 49-year-old man under chronic haemodialysis who developed septic shock after the first BCG maintenance instillation for bladder carcinoma in situ (CIS). Supportive measures and empiric broad-spectrum antibiotic therapy were promptly started after sample collection for cultures. Lastly, the recurrence of fever raised the initial suspicion of BCG dissemination. The diagnosis was confirmed by the identification of the Mycobacterium tuberculosis complex in blood samples collected and anti-tuberculosis therapy was then initiated. We would like to highlight the need for early recognition of a systemic BCG infection and the importance of starting anti-tuberculosis treatment as early as possible.
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Affiliation(s)
- Pedro Francisco Fernandes
- Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Pedro Nunes
- Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
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Seok J, Kwak HJ, Kwak Y, Lee M, Park KS, Kim A, Cho SG. Anti-oncogenic effects of dutasteride, a dual 5-alpha reductase inhibitor and a drug for benign prostate hyperplasia, in bladder cancer. J Transl Med 2023; 21:129. [PMID: 36800968 PMCID: PMC9938606 DOI: 10.1186/s12967-023-03972-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The incidence of bladder cancer (BCa) is approximately four times higher in men than in women. To develop effective BCa treatments, there is an urgent need to understand the differences in the BCa control mechanisms based on gender. Our recent clinical study showed that androgen suppression therapy using 5α-reductase inhibitors and androgen deprivation therapy affects BCa progression, but the underlying mechanisms are still unknown. METHODS mRNA expression levels of the androgen receptor (AR) and SLC39A9 (membrane AR) in T24 and J82 BCa cells were evaluated by reverse transcription-PCR (RT-PCR). The effect of dutasteride, a 5α-reductase inhibitor, in BCa progression was determined in cells transfected with control and AR-overexpressing plasmids. In addition, cell viability and migration assays, RT-PCR, and western blot analysis were performed to analyze the effect of dutasteride on BCa in the presence of testosterone. Finally, steroidal 5α-reductase 1 (SRD5A1), one of the dutasteride target genes, was silenced in T24 and J82 BCa cells using control and shRNA-containing plasmids, and the oncogenic role of SRD5A1 was evaluated. RESULTS Dutasteride treatment led to significant inhibition of the testosterone-induced increase dependent on AR and SLC39A9 in cell viability and migration of T24 and J82 BCa cells and induced alterations in the expression level of cancer progression proteins, such as metalloproteases, p21, BCL-2, NF-KB, and WNT in AR-negative BCa. Furthermore, the bioinformatic analysis showed that mRNA expression levels of SRD5A1 were significantly higher in BCa tissues than in normal paired tissues. A positive correlation between SRD5A1 expression and poor patient survival was observed in patients with BCa. Also, Dutasteride treatment reduced cell proliferation and migration via blocking the SRD5A1 in BCa. CONCLUSIONS Dutasteride inhibited testosterone-induced BCa progression dependent on SLC39A9 in AR-negative BCa and repressed oncogenic signaling pathways, including those of metalloproteases, p21, BCL-2, NF-KB, and WNT. Our results also suggest that SRD5A1 plays a pro-oncogenic role in BCa. This work provides potential therapeutic targets for the treatment of BCa.
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Affiliation(s)
- Jaekwon Seok
- grid.258676.80000 0004 0532 8339Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029 Republic of Korea
| | - Hee Jeong Kwak
- grid.258676.80000 0004 0532 8339Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029 Republic of Korea
| | - Yeonjoo Kwak
- grid.258676.80000 0004 0532 8339Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029 Republic of Korea
| | - Moonjung Lee
- grid.258676.80000 0004 0532 8339Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029 Republic of Korea ,grid.258676.80000 0004 0532 8339Department of Advanced Translational Medicine, Konkuk University, Seoul, 05029 Republic of Korea
| | - Kyoung Sik Park
- grid.411120.70000 0004 0371 843XDepartment of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030 Republic of Korea
| | - Aram Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea.
| | - Ssang-Goo Cho
- Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029, Republic of Korea.
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Spisarova M, Losse S, Jakubec P, Hartmann I, Kral M, Ehrmann J, Szkorupa M, Studentova H, Melichar B. Bacillus Calmette-Guérin pneumonitis after intravesical instillation: Report of two cases and a review of the literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 36628562 DOI: 10.5507/bp.2022.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Intravesical administration of bacillus Calmette-Guérin is standard adjuvant treatment of non-muscle invasive bladder cancer. In spite of the fact that this immunotherapy is locoregional, there are still risk of some complications. METHODS We describe two cases of systemic BCG infection after intravesical administration of BCG vaccine in patients with early stage of bladder cancer. RESULTS Both patients suffered from systemic BCG infection manifesting as BCG pneumonitis. After standard therapy with antituberculotic agents, both of them fully recovered. CONCLUSION BCG infection can occur as a rare but potentially serious complication of this treatment procedure. Gravity of this side effect and its specific therapy require prompt and right diagnosis.
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Affiliation(s)
- Martina Spisarova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Stanislav Losse
- Department of Pneumology and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Petr Jakubec
- Department of Pneumology and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Igor Hartmann
- Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Milan Kral
- Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jiri Ehrmann
- Institute of Molecular and Clinical Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Marek Szkorupa
- 1st Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Hana Studentova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
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Haddad J, Chalret du Rieu H, Ducasse E, Berard X, Caradu C. BCG Aortitis, a Rare Complication of BCG Therapy. EJVES Vasc Forum 2023; 58:23-27. [PMID: 36949865 PMCID: PMC10025951 DOI: 10.1016/j.ejvsvf.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
Introduction Intravesical Bacillus Calmette-Guerin (BCG) is an effective treatment for in situ bladder carcinomas; however, extravesical BCG infection may occur in remote organs in patients with underlying primary immunodeficiency and is a potentially serious complication in 3-5% of cases. It includes granulomatous pneumonia, hepatitis as well as specific dermatological, ophthalmic, and haematopoietic manifestations. Diagnosis is difficult and often based on high clinical suspicion as in many cases Mycobacterium bovis is not isolated. This report presents a rare case of BCGaortitis treated in a tertiary care centre. Report A 74 year old man, with a history of bladder cancer treated with BCG therapy over a year ago, presented with malaise, abdominal pain, anorexia, and significant weight loss for several months associated with acute on chronic renal failure and a tender aneurysm. He was diagnosed with hepatic BCGitis and pararenal BCGaortitis. He was considered too high risk for open surgery after a multidisciplinary team meeting and was treated with a four vessel physician modified endograft (PMEG) and antituberculous therapy. At seven month follow up, he was clinically well and control computed tomography showed a patent endograft with complete exclusion of the aortic aneurysm. Discussion Infectious BCG complications after intravesical BCG administration for in situ bladder carcinomas can lead to severe early and late complications. In the present case, the patient presented with both liver and aortic BCG infection. The lack of positive microbiological data should not discourage clinicians from considering BCG infection even if several months have passed since the last BCG instillation.
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Affiliation(s)
| | | | | | - Xavier Berard
- Corresponding author. Unit of Vascular Surgery, Bordeaux University Hospital, CHU de Bordeaux, France.
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7
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Muacevic A, Adler JR, Pinto P, Romano M, Esteves A. Systemic Bacillus Calmette-Guérin (BCG) Infection With Renal Involvement: A Rare Complication of BCG Immunotherapy. Cureus 2022; 14:e33134. [PMID: 36726926 PMCID: PMC9886377 DOI: 10.7759/cureus.33134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Intravesical instillation of bacillus Calmette-Guérin (BCG) is the adjuvant therapy for superficial urothelial carcinoma of the bladder with the lowest recurrence rates and is well tolerated with minor and self-limiting adverse effects. Serious complications, such as systemic BCG infection, are uncommon as the diagnosis is difficult and, in the majority of cases, Mycobacterium bovis cannot be isolated. We describe a case of a man who presented with prolonged fever associated with polyuria, dysuria, anorexia, and significant weight loss, refractory to several courses of appropriate antibiotic therapy. After an exhaustive investigation, the underlying diagnosis of systemic BCG infection with renal involvement was considered. Antituberculosis treatment resulted in a marked clinical and radiological recovery, supporting this diagnosis.
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8
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Hamie L, Abbas O, Kanj-Sharara S, Abou Rahal J. Erythema induratum of Bazin after intravesical Bacillus Calmette-Guérin immunotherapy. Clin Exp Pharmacol Physiol 2022; 49:544-545. [PMID: 35119123 DOI: 10.1111/1440-1681.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/02/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Lamiaa Hamie
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha Kanj-Sharara
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jihane Abou Rahal
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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9
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Schembri Higgans J, Pace K, Sciberras J, Scicluna W. Systemic BCGosis following intra-renal instillation of BCG: a case report. J Surg Case Rep 2021; 2021:rjab544. [PMID: 34934480 PMCID: PMC8684533 DOI: 10.1093/jscr/rjab544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/07/2021] [Indexed: 12/01/2022] Open
Abstract
Bacillus Calmette-Guerin (BCG) immunotherapy is a mainstay of adjunctive therapy for non-muscle-invasive bladder cancer. The instillation of BCG in the upper urinary tract after complete tumour eradication has also been studied and used after kidney-sparing management. It is effective in increasing the length of remission. However, it is also associated with rare but severe local and systemic side effects which may potentially become life-threatening. We present a case report of a 37-year-old gentleman who developed BCGosis following intra-renal instillation of BCG immunotherapy. The patient presented with systemic symptoms of jaundice, fever, myalgia and arthralgia, rather than local symptoms. Mycobacterium bovis infection was confirmed on blood cultures. The patient also developed hepatosplenomegaly, dyspnoea and pancytopaenia. BCGosis following intravesical instillation has been well documented in literature; to the best of our knowledge, this is the first case report documenting BCGosis following intra-renal instillation.
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Affiliation(s)
| | - Keith Pace
- Department of Surgery, Mater Dei Hospital, Dun Karm Street, Msida MSD2090, Malta
| | - John Sciberras
- Department of Surgery, Mater Dei Hospital, Dun Karm Street, Msida MSD2090, Malta
| | - Warren Scicluna
- Department of Surgery, Mater Dei Hospital, Dun Karm Street, Msida MSD2090, Malta
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Oliveira AA, Morais J, Ribeiro J, Gouveia PF. Systemic infection following intravesical therapy with BCG. BMJ Case Rep 2021; 14:e243641. [PMID: 34753717 PMCID: PMC8578936 DOI: 10.1136/bcr-2021-243641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/03/2022] Open
Abstract
Immunotherapy with BCG is an effective and widely used treatment for non-muscle-invasive bladder cancer. BCG sepsis is a rare but life-threatening and frequently not a straightforward complication of this treatment; in cases with a high index of suspicion, anti-bacillary treatment should not wait for laboratory confirmation and be instituted immediately. We report a severe case of BCG sepsis, in which timely diagnosis and initiation of antituberculosis agents enabled a full recovery.
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Affiliation(s)
| | - Joana Morais
- Department of Internal Medicine, Hospital de Braga, Braga, Portugal
| | - Jorge Ribeiro
- Department of Urology, Hospital de Braga, Braga, Portugal
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Vallilas C, Zachou M, Dolkiras P, Sakellariou S, Constantinou CA, Flevari P, Anastasopoulou A, Androutsakos T. Difficulties in Diagnosing and Treating Disseminated Bacillus Calmette-Guérin (BCG) Infection After Intravesical BCG Therapy in a Patient with Liver Cirrhosis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933006. [PMID: 34654796 PMCID: PMC8525903 DOI: 10.12659/ajcr.933006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patient: Male, 62-year-old
Final Diagnosis: BCGitis
Symptoms: Fever • general fatigue
Medication: —
Clinical Procedure: Bone marrow biopsy • liver biopsy
Specialty: Infectious Diseases • General and Internal Medicine
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Affiliation(s)
- Christos Vallilas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Zachou
- Department of Gastroenterology, Sismanoglio General Hospital, Athens, Greece
| | | | - Stratigoula Sakellariou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Pagona Flevari
- Thalassemia and Sickle Cell Disease Center, Laiko General Hospital, Athens, Greece
| | | | - Theodoros Androutsakos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athnes, Greece
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12
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Azevedo M, Zanetti G, Marchiori E. An uncommon cause of miliary disease: intravesical BCG immunotherapy. J Bras Pneumol 2021; 47:e20210211. [PMID: 34669836 PMCID: PMC9013537 DOI: 10.36416/1806-3756/e20210211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Marcelo Azevedo
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Glaúcia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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13
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Brandi N, Bartalena L, Mosconi C, Golfieri R. A unique case of miliary pulmonary tuberculosis induced by bacillus Calmette-Guérin intravesical instillation with COVID-19 superinfection. SA J Radiol 2021; 25:2122. [PMID: 34230863 PMCID: PMC8252158 DOI: 10.4102/sajr.v25i1.2122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022] Open
Abstract
Intravesical instillation of Bacillus Calmette-Guérin (BCG) is used as an adjuvant treatment of bladder cancer. Systemic BCG infection occurs in less than 1% of cases, and pulmonary involvement is even rarer (0.3% – 0.7%), with a favourable prognosis. A 78-year-old male developed miliary tuberculosis (TB) secondary to intravesical BCG treatment and subsequent coronavirus disease 2019 (COVID-19) superinfection that led to patient death. High awareness amongst clinicians is needed to proceed with immediate appropriate therapy in these patients, especially during the COVID-19 pandemic
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Laura Bartalena
- Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy
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Itai M, Yamasue M, Takikawa S, Komiya K, Takeno Y, Igarashi Y, Takeshita Y, Hiramatsu K, Mitarai S, Kadota JI. A solitary pulmonary nodule caused by Mycobacterium tuberculosis var. BCG after intravesical BCG treatment: a case report. BMC Pulm Med 2021; 21:115. [PMID: 33827514 PMCID: PMC8028358 DOI: 10.1186/s12890-021-01475-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Intravesical instillation of bacillus Calmette–Guérin (BCG) as a treatment for superficial bladder cancer rarely causes pulmonary complications. While published cases have been pathologically characterized by multiple granulomatous lesions due to disseminated infection,
no case presenting as a solitary pulmonary nodule has been reported. Case presentation A man in his 70 s was treated with intravesical BCG for early-stage bladder cancer. After 1 year, he complained of productive cough with a solitary pulmonary nodule at the left lower lobe of his lung being detected upon chest radiography. His sputum culture result came back positive, with conventional polymerase chain reaction (PCR) identifying Mycobacterium tuberculosis complex. However, tuberculosis antigen-specific interferon-gamma release assay came back negative. Considering a history of intravesical BCG treatment, multiplex PCR was conducted, revealing the strain to be Mycobacterium tuberculosis var. BCG. The patient was then treated with isoniazid, ethambutol, levofloxacin, and para-aminosalicylic acid following an antibiotic susceptibility test showing pyrazinamide resistance, after which the size of nodule gradually decreased. Conclusion This case highlights the rare albeit potential radiographic presentation of Mycobacterium tuberculosis var. BCG, showing a solitary pulmonary nodule but not multiple granulomatous lesions, after intravesical BCG treatment. Differentiating Mycobacterium tuberculosis var. BCG from Mycobacterium tuberculosis var. tuberculosis is crucial to determine whether intravesical BCG treatment could be continued for patients with bladder cancer.
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Affiliation(s)
- Mariko Itai
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan
| | - Mari Yamasue
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan.,Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Shuichi Takikawa
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan
| | - Kosaku Komiya
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan. .,Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Yukiko Takeno
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan.,Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yuriko Igarashi
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24, Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Yasushi Takeshita
- Department of Internal Medicine, Tsukumi Chuo Hospital, 6011 Chinu, Tsukumi, Tsukumi, Oita, 879-2401, Japan
| | - Kazufumi Hiramatsu
- Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Satoshi Mitarai
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24, Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
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Guallar-Garrido S, Julián E. Bacillus Calmette-Guérin (BCG) Therapy for Bladder Cancer: An Update. Immunotargets Ther 2020; 9:1-11. [PMID: 32104666 PMCID: PMC7025668 DOI: 10.2147/itt.s202006] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/28/2020] [Indexed: 01/02/2023] Open
Abstract
Physicians treating patients affected by nonmuscle-invasive bladder cancer (NMIBC) have been in shock during the last six years since manufacturing restrictions on the production of the first-option medicine, Mycobacterium bovis Bacillus Calmette-Guérin (BCG), have resulted in worldwide shortages. This shortage of BCG has led to a rethinking of the established treatment guidelines for the rationing of the administration of BCG. Some possible schedule modifications consist of a decrease in the length of maintenance treatment, a reduction in the dose of BCG in intravesical instillations or the use of different BCG substrains. All these strategies have been considered valuable in times of BCG shortage. In addition, the lack of availability of BCG has also led to the general recognition of the need to find new treatment options for these patients so that they are not dependent on a single treatment. Few alternatives are committed to definitively replacing BCG intravesical instillations, but several options are being evaluated to improve its efficacy or to combine it with other chemotherapeutic or immunotherapeutic options that can also improve its effect. In this article, we review the current state of the treatment with BCG in terms of all of the aforementioned aspects.
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Affiliation(s)
- Sandra Guallar-Garrido
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
| | - Esther Julián
- Departament de Genètica i de Microbiologia, Facultat de Biociències, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
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