title: Mycobacterial infection after intravesical bacillus Calmette-Guërin treatment for bladder cancer: a case report.
abstract: Bacillus Calmette-Guërin (BCG) has been traditionally used as a vaccine against tuberculosis. Further, intravesical administration of BCG has been shown to be effective in treating bladder cancer. Although BCG contains a live attenuated strain of Mycobacterium bovis, complications such as M. bovis BCG infection caused by BCG administration are extremely rare. Here, we report a case of BCG infection occurring after intravesical BCG therapy. A 67-yr-old man presented with azotemia and weight loss. He had been diagnosed with bladder cancer 4 yr back, and had undergone transurethral resection of the bladder tumor and intravesical BCG (Tice strain) therapy at that time. An acid-fast bacterial strain was isolated from his urine sample. We did not detect Mycobacterium tuberculosis protein 64 (MPT-64) antigen in the isolates obtained from his sample, and multiplex PCR and PCR-reverse blot hybridization assay indicated that the isolate was a member of the M. tuberculosis complex, but was not M. tuberculosis. Finally, sequence analysis of 16S ribosomal RNA and DNA gyrase, subunit B (gyrB) suggested that the organism was M. bovis or M. bovis BCG. Although we could not confirm that M. bovis BCG was the causative agent, the results of the 3 molecular methods and the MPT-64 antigen assay suggest this finding. This is an important finding, especially because M. bovis BCG cannot be identified using common commercial molecular genetics tools.
authors.affiliation: Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Chang-Hun
authors.initials: CH
authors.lastname: Park
authors.forename: Mi Ae
authors.initials: MA
authors.lastname: Jang
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Ahn
authors.forename: Yu-Yean
authors.initials: YY
authors.lastname: Hwang
authors.forename: Chang-Seok
authors.initials: CS
authors.lastname: Ki
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D027081:DNA Gyrase / Q000235:genetics; D006801:Humans; D008297:Male; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000209:etiology; D009163:Mycobacterium bovis / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D001749:Urinary Bladder Neoplasms / Q000628:therapy*
chemical_list: D001500:BCG Vaccine; D012336:RNA, Ribosomal, 16S; D027081:DNA Gyrase