title: Late bacille Calmette-Guérin infection with a large focal urinary bladder ulceration as a complication of bladder cancer treatment.
abstract: OBJECTIVE
  • To report a late bacille Calmette-Guérin (BCG) complication previously not described in the literature.
  
  
  METHODS
  • We reviewed our database with 858 patients treated with BCG from 1986 to 2008 and identified 13 male patients (1.8% of all male patients) who had a large tuberculous-like bladder ulcer.
  
  
  RESULTS
  • All patients had high-grade tumours and seven had tumours invading lamina propria before BCG treatment. A solitary ulceration or inflammatory lesion, 10-50 mm in diameter, was seen at routine follow-up cystoscopy 2-34 months (median 8 months) after the first instillation. Significantly more patients had been treated with BCG-RIVM than with BCG-Tice (10/320 vs. three of 454, P < 0.01). BCG was cultured from urine 3-34 months (median 14 months) after the last instillation. • So far, eight patients have been successfully treated with rifampicin and isoniazid. Nine patients are still tumour-free 15-66 months (median 44 months) after the last transurethral resection before BCG treatment. • Another three patients had one to two non-invasive recurrences. One patient had an invasive recurrence and underwent cystectomy. The present study is limited by biases associated with its retrospective design.
  
  
  CONCLUSIONS
  • This is the first report on persisting BCG infections with large inflammatory lesions in the bladder. Treatment is effective and the oncological outcome is good. • Mycobacterial cultures of the urine should be performed in BCG-patients with unclear inflammatory lesions in the bladder since a delayed diagnosis of a persistent BCG infection could result in a permanently reduced bladder capacity. • Large studies are warranted to study differences in efficacy and side-effects between different BCG strains.
authors.affiliation: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden. viveka.strock@vgregion.se
authors.forename: Viveka
authors.initials: V
authors.lastname: Ströck
authors.forename: Leif
authors.initials: L
authors.lastname: Dotevall
authors.forename: Torsten
authors.initials: T
authors.lastname: Sandberg
authors.forename: Christina Kåbjörn
authors.initials: CK
authors.lastname: Gustafsson
authors.forename: Sten
authors.initials: S
authors.lastname: Holmäng
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001500:BCG Vaccine / Q000009:adverse effects*; D015653:Cystectomy; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009163:Mycobacterium bovis / Q000302:isolation & purification; D014401:Tuberculosis, Urogenital / Q000188:drug therapy / Q000209:etiology* / Q000652:urine; D001743:Urinary Bladder / Q000382:microbiology; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000904:Antibiotics, Antitubercular; D000970:Antineoplastic Agents; D001500:BCG Vaccine