Cutaneous complications of intravesical treatments for bladder cancer: Granulomatous inflammation of the penis following BCG therapy and penile gangrene following mitomycin therapy

Kureshi, Faraz; Kalaaji, Amer N.; Halvorson, Larry; Pittelkow, Mark R.; Davis, Mark D.P.

doi:10.1016/j.jaad.2005.07.041

Cited by 22 publications

(14 citation statements)

References 14 publications

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“…[1] Primary infection of glans penis is an extremely rare complication of this therapy and we report here one such case. [2][3][4][5][6][7][8][9][10][11][12][13] …”

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confidence: 99%

Primary tuberculosis of glans penis after intravesical bacillus calmette guerin immunotherapy

Sharma¹,

Sethy²,

Dogra³

et al. 2011

Indian J Dermatol Venereol Leprol

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A 55-year-old male with carcinoma in situ of urinary bladder was treated with weekly intravesical injections of Bacillus Calmette Guerin (BCG) vaccine. Three days after the sixth injection, he developed low grade fever and multiple grouped punched out, 2-3 mm ulcers around meatus and corona glandis. In addition, multiple, firm, indurated, nontender papules and few deeper nodules were present on the proximal part of glans penis, along with bilateral enlarged, matted and nontender inguinal lymph nodes. There was no history suggestive of sexually transmitted diseases and high risk behavior. Chest X-ray was within normal limits, and Mantoux, Venereal Disease Research Laboratory (VDRL) and HIV antibody tests were negative. The biopsy from the penile ulcer revealed epithelioid cell granuloma with Langhans giant cells. Fine needle aspiration cytology from the lymph node also revealed epithelioid cell granuloma and acid fast bacilli on Ziehl Neelsen's stain. The tissue biopsy grew Mycobacterium tuberculosis. The BCG immunotherapy was stopped and patient was treated with four drug antitubercular therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide in standard daily doses along with pyridoxine. The edema resolved and the ulcers started healing within 2 weeks, and at 6 weeks after starting antitubercular therapy almost complete healing occurred. To the best of our knowledge, we describe the first case of an Indian patient with BCG induced primary tuberculosis of penis after immunotherapy for carcinoma urinary bladder and review the previously described cases to increase awareness of this condition in dermatologists and venereologists.

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“…[1] Primary infection of glans penis is an extremely rare complication of this therapy and we report here one such case. [2][3][4][5][6][7][8][9][10][11][12][13] …”

mentioning

confidence: 99%

Primary tuberculosis of glans penis after intravesical bacillus calmette guerin immunotherapy

Sharma¹,

Sethy²,

Dogra³

et al. 2011

Indian J Dermatol Venereol Leprol

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“…The presence of inguinal lymphadenopathies is frequent. [8][9][10][11][12][13][14] In the case described above, only erythematous and asymptomatic nodules were observed on the glans penis, which could easily go undetected in a clinical examination. In our patient, there was a temporal association with BCG immunotherapy and particularly with a traumatic instillation.…”

Section: Discussionmentioning

confidence: 99%

“…However, the time interval between BCG immunotherapy and the onset of skin lesions has been variable, occurring both immediately after the instillation or 1 year after the end of treatment. [8][9][10] The mechanism of infection seems to be related to a history of traumatic urethral catheterization prior to BCG instillation with direct penis inoculation; however, this risk factor is not always identified. 8,9,11,13 Histologically, tuberculoid granulomas with giant cells are observed.…”

Section: Discussionmentioning

confidence: 99%

“…The difficult identification of M. bovis by traditional methods (Ziehl-Neelsen stain and culture) has been described in literature 8,9,12,13 . This problem may be overcome by the utilization of polymerase chain reaction (PCR), a method that has been shown to be more effective and more specific in BCG detection.…”

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confidence: 99%

“…Nevertheless, as is shown in Chart I, the duration of the treatment has varied, as well as the number of antitubercular agents used. [8][9][10][11][12][13][14] The treatment scheme recommended for other genitourinary complications with local-regional granulomatous inflammation consists of isoniazid and rifampicine for 3 to 6…”

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confidence: 99%

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Granulomas do pênis: uma complicação rara da terapia intravesical com Bacilo Calmette-Guérin

Lestre

Gameiro

João

et al. 2011

An. Bras. Dermatol.

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Abstract:Immunotherapy with Bacillus Calmette-Guérin is widely used for treatment and prophylaxis of superficial urothelial cancer. Complications associated with Bacillus Calmette-Guérin treatment are common. The authors describe a case of granulomatous inflammation of the penis associated with intravesical Bacillus Calmette-Guérin therapy, presenting with multiple erythematous and painless nodules located on the glans. A review of the literature is also performed. Granulomatous balanoposthitis is a rare complication of Bacillus Calmette-Guérin immunotherapy, with heterogeneous clinical presentation, which can make the diagnosis difficult. Its clinical recognition is essential for early start of therapy with antitubercular agents and interruption of Bacillus Calmette-Guérin. Keywords: Administration, intravesical; Antitubercular Agents; Inflammation; Mycobacterium bovis; Penis Resumo: A imunoterapia com o Bacilo Calmette-Guérin é amplamente usada no tratamento e profilaxia da neoplasia urotelial superficial. As complicações associadas ao tratamento são comuns. Os autores relatam um caso de inflamação granulomatosa do pênis, associada à terapia intravesical com Bacilo Calmette-Guérin, com múltiplos nódulos eritematosos indolores localizados na glande. É também efetuada uma revisão da literatura. A balanopostite granulomatosa é uma complicação rara associada à imunoterapia com Bacilo Calmette-Guérin, com uma apresentação clinicamente heterogênea que pode dificultar o diagnóstico. O seu reconhecimento clínico é essencial para o início precoce de tuberculostáticos e interrupção de Bacilo Calmette-Guérin.

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The granulomatous reaction pattern

Weedon

2010

Weedon's Skin Pathology

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Cutaneous complications of intravesical treatments for bladder cancer: Granulomatous inflammation of the penis following BCG therapy and penile gangrene following mitomycin therapy

Cited by 22 publications

References 14 publications

Primary tuberculosis of glans penis after intravesical bacillus calmette guerin immunotherapy

Primary tuberculosis of glans penis after intravesical bacillus calmette guerin immunotherapy

Granulomas do pênis: uma complicação rara da terapia intravesical com Bacilo Calmette-Guérin

The granulomatous reaction pattern

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