[Tuberculosis miliar in a patient treated with intravesical instillations of bacillus Calmette-Guérin].
Tuberculosis miliar is a very rare complication of bacillus Calmette-Guérin (BCG) immunotherapy that is associated to high mortality. Thus, early diagnosis and treatment is essential. At present, there is a polymerase chain reaction technique (PCR) which is a rapid diagnostic method with elevated sensitivity. Treatment with tuberculostatic agents should be initiated as soon as possible, the combination of corticosteroids and cycloserine in serious cases being advisable. A case of a 75 year old patient with intravesical BCG instillations after a transurethral resection of bladder cancer is presented. He was admitted to the Intensive Care Unit (ICU) due to severe acute respiratory failure evolving to acute respiratory distress syndrome (ARDS). Mycobacterium bovis DNA was identified by PCR in blood samples and bronchoaspirate (BAS). He was treated with tuberculostatic agents and corticosteroids, dying due to respiratory failure.
Del Castillo Duran
Y
Y
Unidad de Cuidados Intensivos, Hospital de Sant Pau i Santa Tecla, Tarragona, España. ucista@sv.ftecla.es
Santos Bodí
F
F
Castander Serentill
D
D
Jubert Montaperto
P
P
Espinosa Valencia
P
P
Rabassó Sole
C
C
D000276:Adjuvants, Immunologic / Q000008:administration & dosage* / Q000009:adverse effects; D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000008:administration & dosage* / Q000009:adverse effects; D004269:DNA, Bacterial / Q000097:blood; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D009163:Mycobacterium bovis / Q000235:genetics; D016133:Polymerase Chain Reaction; D013902:Radiography, Thoracic; D014391:Tuberculosis, Miliary / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine; D004269:DNA, Bacterial