[Generalized BCG infection after intravesical instillations of Calmette-Guerin bacillus].
BCG has been disappointing as immunotherapy of numerous cancers, but it has been clinically successful in the intravesical treatment of bladder carcinomas sparing the muscle coat; it has indeed become the reference treatment for this type of cancer. However, complications are repeatedly reported, including generalized BCGitis. We report such a case with positive BCG culture. From the cases already published there emerges a homogeneous and often subacute clinical presentation suggestive of an ordinary pathogen. Bacteriology is not very helpful, even when recent techniques are used, and therefore the diagnosis rests on the context and, when samples are taken, on suggestive histological findings. To discuss the physiopathology of BCGitis--generalized immune reaction or multifocal BCG proliferation--is not useless since treatment depends on it. It is probable that these 2 mechanisms working together can be incriminated justifying the prescription of both antibiotics and corticosteroids. When this is done, the prognosis seems to be favourable in most patients. Yet a strict respect of contra-indications and a very careful subsequent radiotherapy should reduce the risks.
de Saint Martin
L
L
Service de Médecine interne, Hôpital Saint Joseph, Paris.
Boiron
C
C
Poveda
J D
JD
Herreman
G
G
D000283:Administration, Intravesical; D000368:Aged; D000900:Anti-Bacterial Agents; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006529:Hepatomegaly / Q000209:etiology; D006562:Herpes Zoster / Q000209:etiology; D006801:Humans; D008297:Male; D009164:Mycobacterium Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D009163:Mycobacterium bovis / Q000302:isolation & purification*; D010212:Papilloma / Q000188:drug therapy*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D001500:BCG Vaccine
BCGite généralisée après instillations intravésicales de bacilles de Calmette-Guérin.