title: Complications following intravesical bacillus Calmette-Guerin treatment for bladder cancer: a case series of 22 patients.
abstract: BACKGROUND
  Intravesical bacillus Calmette-Guerin (BCG) therapy is an effective and widely used treatment for superficial bladder carcinoma. Local complications are frequent whereas systemic complications are rare but can be serious, and their management is not well known.
  
  
  METHODS
  We describe retrospectively the records of 22 patients treated in 3 infectious disease departments, for complications related to intravesical BCG therapy as treatment of bladder cancer.
  
  
  RESULTS
  All the patients were male, with a median age of 68 years (range 56-88). Complications occurred after a median of 5 instillations (range 1-11) and were observed within 24 h following BCG instillation for 14 patients. Common symptoms were fever (n = 20), impaired general condition (n = 14), and shortness of breath (n = 7). Six patients had a systemic septic reaction leading to transfer into the intensive care unit for five of them. Lung infiltration was the most frequent presentation (n = 11). Mycobacterium bovis was isolated from only two patients, but histology showed the presence of a granuloma in nine patients. Antimycobacterial treatment was initialized in 17 patients; the outcome was favorable in 16 patients, with a median length of symptoms resolution of 22.5 days (range 5-425 days). Eleven patients received corticosteroids in addition to specific treatment and had a more rapid improvement. One patient died with disseminated BCGitis proved by biopsy.
  
  
  CONCLUSIONS
  Complications following intravesical BCG therapy are rare but can be severe and fatal. Histology seems to be the method that contributes most in confirmation of the diagnosis. Antimycobacterial therapy is effective, and probably more efficient when combined with corticosteroids, but the regimen and duration of the treatment are not standardized.
authors.affiliation: Infectious and Tropical Diseases Department, Bichat Hospital, AP-HP , Paris , France.
authors.forename: J D
authors.initials: JD
authors.lastname: Pommier
authors.forename: N
authors.initials: N
authors.lastname: Ben Lasfar
authors.forename: N
authors.initials: N
authors.lastname: Van Grunderbeeck
authors.forename: C
authors.initials: C
authors.lastname: Burdet
authors.forename: C
authors.initials: C
authors.lastname: Laouénan
authors.forename: C
authors.initials: C
authors.lastname: Rioux
authors.forename: C
authors.initials: C
authors.lastname: Pierre-Audigier
authors.forename: A
authors.initials: A
authors.lastname: Meybeck
authors.forename: L
authors.initials: L
authors.lastname: Choudat
authors.forename: A
authors.initials: A
authors.lastname: Benchikh
authors.forename: S
authors.initials: S
authors.lastname: Nguyen
authors.forename: E
authors.initials: E
authors.lastname: Bouvet
authors.forename: P
authors.initials: P
authors.lastname: Yeni
authors.forename: Y
authors.initials: Y
authors.lastname: Yazdanpanah
authors.forename: V
authors.initials: V
authors.lastname: Joly
mesh_terms: D000283:Administration, Intravesical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001500:BCG Vaccine / Q000008:administration & dosage* / Q000009:adverse effects*; D002417:Cattle; D004359:Drug Therapy, Combination; D006099:Granuloma / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009163:Mycobacterium bovis / Q000187:drug effects / Q000302:isolation & purification*; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D000970:Antineoplastic Agents; D001500:BCG Vaccine
keywords: BCG; Mycobacterium bovis; bladder cancer; intravesical instillation