[Miliary pulmonary tuberculosis following intravesical BCG-therapy].
A patient given intravesical BCG immunotherapy developed miliary pulmonary tuberculosis. After resection of a superficial bladder tumor, the patient was given weekly intravesical BCG infusions. After the 4th session, the patient developed fever (40 degrees C), shivers, dry cough, profuse sweating, and weight loss. Initially, the chest x-ray was normal. The patient was given isoniazid (5 mg/kg) in a single-drug regimen. Rapid degradation of the general status led to a new chest x-ray, 10 days later, which demonstrated a reticulonodular syndrome. High-resolution thoracic CT confirmed the diagnosis of miliary pulmonary tuberculosis. A three-drug antituberculosis regimen associated with corticosteroids was followed by restoration of the general status. Antituberculosis therapy was continued for 9 months. The 9-month thoracic CT revealed a smaller number of micronodules in the pulmonary parenchyma. This case illustrates the discussion concerning the appropriate treatment for patients who develop a systemic infection after intravesical BCG-therapy.
Youssef
M
M
Service de Pneumologie et d'Explorations Fonctionnelles et Respiratoires, CHU Bretonneau, 2, boulevard Tonnellé, 37044 Tours 1.
Carre
P
P
Asquier
E
E
Janin
P
P
Lemarie
E
E
Diot
P
P
D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects*; D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011859:Radiography; D014391:Tuberculosis, Miliary / Q000000981:diagnostic imaging / Q000209:etiology*; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology*
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine