title: Disseminated Mycotic Aneurysms following Intravesical Bacillus Calmette-Guérin Therapy for Bladder Cancer: Case Discussion and Systematic Treatment Algorithm.
abstract: Numerous case reports have highlighted the relationship between bacillus Calmette-Guérin (BCG) therapy and development of systemic mycotic aneurysms but none have established a management algorithm in patients with suspected vascular dissemination of Mycobacterium bovis. Delay in diagnosis of this disease process will lead to delays in initiation of antimycobacterium treatment to prevent dissemination into other arterial beds and potentially complicate effective surgical treatment leading to aneurysmal rupture and other devastating vascular consequences. Given the increasing number of reported cases in the literature and the ongoing, standard of care utilization of BCG for bladder cancer, we believe that a systematic approach to the management of patients with suspected BCG-related mycotic aneurysms should be set in place to prevent misdiagnosis and delays in treatment. In this report, we discuss the presentation, work-up, and report our treatment algorithm of a patient who developed diffuse peripheral mycotic aneurysms following BCG therapy for bladder cancer.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Cheong J
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Daniel
authors.initials: D
authors.lastname: Davila
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address: andua@mcw.edu.
authors.forename: Anahita
authors.initials: A
authors.lastname: Dua
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Brian
authors.initials: B
authors.lastname: Keyashian
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Justin
authors.initials: J
authors.lastname: Dux
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Seabrook
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Kellie
authors.initials: K
authors.lastname: Brown
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Michael
authors.initials: M
authors.lastname: Malinowski
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hieb
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Brian
authors.initials: B
authors.lastname: Lewis
mesh_terms: D000283:Administration, Intravesical; D000465:Algorithms; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation; D000072226:Computed Tomography Angiography; D019091:Critical Pathways; D057510:Endovascular Procedures; D006801:Humans; D008297:Male; D008875:Middle Aged; D009163:Mycobacterium bovis / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D014381:Tuberculosis, Cardiovascular / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D000995:Antitubercular Agents; D001500:BCG Vaccine