[BCG infection of the glans penis after intravesical BCG therapy].
BACKGROUND
BCG therapy is an effective adjuvant treatment for superficial bladder tumors. Therapy involves intravesical instillation of live attenuated Calmette-Guérin bacilli. BCG infection of the glans is a rare local complication associated with this treatment, two cases of which are reported below.


METHODS
Case 1: A 77-year-old man presented relapsing urothelial bladder carcinoma treated by endoscopic resection and BCG therapy. One week after the seventh instillation, severe balanitis developed. Three months later, examination revealed massive painful perimeatal ulceration with yellowish papules in the peripheral regions. Histology revealed epithelioid giant-cell granulomas. Ziehl-Neelsen staining was positive. Slow cure of the lesions was achieved within 12months using double antitubercular antibiotic therapy. Case 2: In a 61-year-old man receiving BCG therapy for relapsing bladder carcinoma in situ, the sixth instillation was considered traumatic since it was highly painful. One week later, papular nodules appeared on the glans with a sclerosing lesion of the balanopreputial sac, dark purple perimeatal papules and a mass beneath the mucosa of the glans. Antibiotic treatment comprising ofloxacin followed by rifampicin for two months proved ineffective. Histology revealed granulomatous dermal lesions with eosinophilic necrosis. Triple antitubercular antibiotic therapy was initiated.


CONCLUSIONS
The first reported case of BCG infection of the glans in patients undergoing intravesical BCG therapy was published in 1992. Since then, there have been nine other reports. There is no stereotypical clinical presentation. In most cases, an infiltrated erythematosus plaque is seen together with yellowish papules in certain patients. Diagnosis is based upon history and histological examination.
Michelet
N
N
Service de dermatologie, hôpital Fournier, CHU de Nancy, 36, quai de la Bataille, 54035 Nancy cedex, France.
Spenatto
N
N
Viraben
R
R
Cuny
J-F
JF
Mazet
J
J
Trechot
P
P
Barbaud
A
A
Schmutz
J-L
JL
D000276:Adjuvants, Immunologic / Q000008:administration & dosage* / Q000009:adverse effects*; D000283:Administration, Intravesical; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage / Q000627:therapeutic use; D001500:BCG Vaccine / Q000008:administration & dosage* / Q000009:adverse effects*; D001446:Balanitis / Q000209:etiology* / Q000473:pathology; D001706:Biopsy; D002278:Carcinoma in Situ / Q000628:therapy*; D002295:Carcinoma, Transitional Cell / Q000601:surgery / Q000628:therapy*; D004359:Drug Therapy, Combination; D006101:Granuloma, Giant Cell / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D010413:Penis / Q000473:pathology; D014376:Tuberculosis / Q000188:drug therapy / Q000209:etiology*; D001749:Urinary Bladder Neoplasms / Q000601:surgery / Q000628:therapy*
D000276:Adjuvants, Immunologic; D000904:Antibiotics, Antitubercular; D001500:BCG Vaccine