title: Fatal sepsis following intravesical bacillus Calmette-Guerin administration for bladder cancer.
abstract: Intravesical administration of bacillus Calmette-Guerin has been shown to be highly effective treatment of superficial bladder cancer. Complications from bacillus Calmette-Guerin therapy are usually minor but serious and even fatal reactions can occur. Five recent cases illustrate the gravity of bacillus Calmette-Guerin sepsis. One man with severe debility and the organic brain syndrome died acutely with a fever of 40 C. Two men had frank sepsis that progressed to multiorgan failure and death. Sepsis progressed despite the use of isoniazid, rifampin and streptomycin. Two men who had equally progressive sepsis with intravesical bacillus Calmette-Guerin survived with the use of cycloserine for the first 72 hours of treatment. Triple antituberculous antibiotics, including cycloserine, may be lifesaving. Sepsis resulted from intravenous absorption through inflamed or disrupted urothelium. Bacillus Calmette-Guerin treatment should not be administered in the presence of severe cystitis or after grossly traumatic catheterization.
authors.affiliation: Department of Urology, West Virginia University Health Sciences Center, Morgantown.
authors.forename: W H
authors.initials: WH
authors.lastname: Rawls
authors.forename: D L
authors.initials: DL
authors.lastname: Lamm
authors.forename: B A
authors.initials: BA
authors.lastname: Lowe
authors.forename: E D
authors.initials: ED
authors.lastname: Crawford
authors.forename: M F
authors.initials: MF
authors.lastname: Sarosdy
authors.forename: J E
authors.initials: JE
authors.lastname: Montie
authors.forename: H B
authors.initials: HB
authors.lastname: Grossman
authors.forename: P T
authors.initials: PT
authors.lastname: Scardino
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000628:therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology*; D014376:Tuberculosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D001749:Urinary Bladder Neoplasms / Q000628:therapy*
chemical_list: D000904:Antibiotics, Antitubercular; D001500:BCG Vaccine