Dactilitis and oligoarthritis after BCG immunotherapy in a patient affected by bladder cancer

Manzini, Cu; Bernini, L. F.; Elkhaldi, Nezar Moneir Fadl; Mascia, Maria Teresa; Ferri, Clodoveo

doi:10.4081/reumatismo.2006.230

Cited by 5 publications

(6 citation statements)

References 9 publications

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“…Therefore, we included a total of 201 articles comprising 271 cases of BCG infection after intravesical instillation published since 1975. 1 – 14 , 17 – 19 , 21 – 31 , 33 – 39 , 41 – 49 , 51 – 71 , 73 – 80 , 82 – 84 , 87 – 97 , 99 , 101 , 102 , 104 , 105 , 107 – 119 , 121 – 138 , 140 – 151 , 153 – 168 , 170 , 171 , 173 – 180 , 182 – 189 , 192 , 193 , 195 – 202 , 205 – 208 , 210 – 214 , 218 , 219 , 221 – 223 , 225 – 232 Of these, 170 were individually detailed cases, and 31 were summarized in reports containing 2–13 cases. All data shown here were extracted from these case reports and case series, but occasionally articles lacked relevant clinical or microbiologic data.…”

Section: Methodsmentioning

confidence: 99%

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

et al. 2014

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Bacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0–9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p < 0.001 for all comparisons). Attributable mortality was higher for patients aged ≥65 years (7.4% vs 2.1%; p = 0.091) and those with disseminated infection (9.9% vs 3.0%; p = 0.040) and vascular involvement (16.7% vs 4.6%; p = 0.064). The scheduled BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy.

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Section: Methodsmentioning

confidence: 99%

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

et al. 2014

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“…The most commonly involved joints are the knee, wrist, and ankle. In addition to arthritis, patients may exhibit dactylitis, urethritis, and uveitis (7,12,13,14). Elevated acute phase reactants, inflammatory response in the synovial fluid, and negative mycobacterial cultures of synovial fluid are expected findings of laboratory studies.…”

Section: Discussionmentioning

confidence: 99%

A Rare Side Effect of Intravesical Bacillus Calmette-Guérin Therapy: Reactive Arthritis

Kizilgok¹,

İzol²,

Erken³

et al. 2018

uob

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Approximately 70-80% of bladder cancers are superficial tumors and not muscle invasive. Complete transurethral resection of the bladder tumour (TUR-BT) is the standard approach to these patients. Intravesical treatments such as adriamycin, doxorubicin, epirubicin, mitomycin-c and Bacillus Calmette-Guérin (BCG) may be performed after TUR-BT in order to prevent further recurrence or progression. BCG is generally used in high-risk patients and causes local or systemic side effects in less than 5% of patients. Osteoarticular side effects are very rare and usually manifest as joint pain and arthritis (%0.5-1). In this case report, we present the management of reactive arthritis in a patient treated with intravesical BCG for bladder cancer.

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“…Poncet’s arthritis secondary to BCG usually occurs in men between 50 and 60 years of age, manifesting as asymmetric arthritis, normally found in wrists, ankles and knees, and fever associated in more than half of cases [ 19 ]. Dactylitis [ 20 ] and urethritis [ 21 ] have also been described as part of this clinical picture. It develops mostly after the fourth or fifth instillation.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that the mechanism by which the instillation of BCG induces Poncet’s disease is molecular mimicry, once the heat shock protein HSP65 of mycobacteria shares homology with a human cartilage proteoglycan, and also presents cross-reactivity with the haplotypes of HLA-DR1, DR3 and DR4, stimulating the secretion of cytokines and activation of CD8 (+) [ 20 ]. The autoimmune response induced by the administration of BCG occurs more frequently in patients with HLA-B27 (+) (nearly 60% of reported cases) or B7 (+) (which shows strong affinity with HLA-B27) [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Poncet’s disease after the intravesical instillation of Bacillus Calmette–Guérin (BCG): a case report

Sampaio¹,

Lira²,

Ribeiro³

et al. 2017

BMC Res Notes

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BackgroundPoncet’s disease is a rare syndrome characterized by articular impairment in a form of rare tuberculid. One of the theories of its cause involves an autoimmune response induced by the intravesical administration of the Calmette–Guerin Bacillus or the treatment of bladder carcinoma. Furthermore, there may be an appearance of oligoarticular or polyarticular arthritis, beginning 1–3 months after the start of therapy. Few physicians know the disease and the literature related to that syndrome is scarce and restricted to case reports, which contributes to its under diagnosis.Case presentationFemale patient, 64 years old, Caucasian, in whom was noticed firstly dark urine, without haematuria or dysuria. Later felt also colic pain in the hypogastric region. Microscopically, the conclusive diagnosis was a high grade non-invasive papillary urothelial carcinoma. Thereupon, the treatment of the tumour began with transurethral resection technique and intravesical instillation of Calmette–Guérin Bacillus as adjuvant treatment. Eight months after the beginning of treatment, the lingering presence of the carcinoma was identified. Nevertheless, arthritis was identified through radiographs, after an increase in the clavicle capitation, right knee and left ankle in bone scintigraphy. Coinciding with the joint manifestations, the patient developed fever and purulent urethral discharge (culture was negative). Therefore, trying to investigate the cause of the arthritis, Purified Protein Derivate was taken, with reactive results. An increase of acute phase reactants was found, with other tests resulting normal: blood chemistry, Complete Blood Count, immunology and serology. Human Leukocyte Antigen typing by polymerase chain reaction revealed the presence of A24/AX, B44, B27, BW4/BW4, DQ7 and DQ5. Consequently, Poncet’s disease was the diagnostic conclusion. The treatment with intravesical Calmette–Guérin Bacillus was immediately discontinued. The patient received corticosteroids associated with etoricoxib and isoniazid for 4 months, achieving disappearance of the inflammatory joint signs in 3 months. After 6 months, no joint pain recurrence or other manifestations suggesting active disease had been seen.ConclusionsTherefore, such diagnosis should be considered when confronted with an osteoarticular clinical picture in patients treated with intravesical Calmette–Guérin Bacillus, especially patients with HLA-B27 (+) and B7 (+), as Poncet’s disease is a reactive arthritis.

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Dactilitis and oligoarthritis after BCG immunotherapy in a patient affected by bladder cancer

Cited by 5 publications

References 9 publications

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

Bacillus Calmette-Guérin (BCG) Infection Following Intravesical BCG Administration as Adjunctive Therapy For Bladder Cancer

A Rare Side Effect of Intravesical Bacillus Calmette-Guérin Therapy: Reactive Arthritis

Poncet’s disease after the intravesical instillation of Bacillus Calmette–Guérin (BCG): a case report

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