Disseminated Mycotic Aneurysms following Intravesical Bacillus Calmette–Guérin Therapy for Bladder Cancer: Case Discussion and Systematic Treatment Algorithm

Lee, Cheong; Davila, Daniel; Dua, Anahita; Keyashian, Brian; Dux, Justin; Seabrook, Gary R.; Brown, Kellie R.; Malinowski, Michael J.; Hieb, Robert A.; Lewis, Brian D.

doi:10.1016/j.avsg.2016.05.120

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…Only a few reported cases have shown evidence of typical caseating granuloma in histopathologic examination, so the definitive diagnosis of mycotic aneurysms is based on culture of the aneurysm specimen [ 45 ]. Besides this gold standard, microbiological acid-fast bacilli detection and PCR from various tissue samples have been reported [ 48 ]. Treatment of mycotic aneurysms includes anti-TB therapy and vascular surgery.…”

Section: Systemic Complicationsmentioning

confidence: 99%

Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

Liu

Huang

et al. 2019

Journal of Oncology

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Because of its proven efficacy, intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is an important treatment for nonmuscle invasive bladder cancer at high risk of recurrence or progression. However, approximately 8% of patients have to stop BCG instillation as a result of its complications. Complications induced by BCG therapy can have a variety of clinical manifestations. These adverse reactions may occur in conjunction with BCG instillation or may not develop until months or years after BCG cessation. An essential step in the management complications arising from BCG is early establishment of diagnosis, particularly for distant, disseminated, and obscure infections. Therefore we reviewed the literature on the potential complications after intravesical BCG immunotherapy for bladder cancer and provide an overview on the incidence, diagnosis, and treatment modality of genitourinary and systemic BCG-induced complications.

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Section: Systemic Complicationsmentioning

confidence: 99%

Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

Liu

Huang

et al. 2019

Journal of Oncology

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“…Up to 70% of mycotic aortic aneurysms due to BCG present with rupture 3 . Thus, clinicians who observe a pattern of contiguous aortic and spinal infection and elicit a history of BCG exposure have a rare opportunity to prevent significant morbidity.…”

Section: What Is Your Diagnosis?mentioning

confidence: 99%

“…A 12-month duration of therapy, analogous to spinal tuberculosis, is planned. 3,4 Bladder cancer is the twelfth most common cause of cancer and the fourteenth most frequent cause of cancer death worldwide. 5 After surgical excision, intravesicular BCG is recommended for all high-grade and some low-grade nonmuscle invasive bladder cancers.…”

Section: What Is Your Diagnosis?mentioning

confidence: 99%

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Contiguous Mycotic Abdominal Aortic Aneurysm and Vertebral Osteomyelitis

Misch¹,

Brennan³

2021

Infectious Diseases in Clinical Practice

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“…The immune escape of bulky lesions was reversible with the addition of a systemic PD-1 blockade [ 10 , 12 ]. Because BCG immunotherapy induces sepsis [ 13 ], live vaccines must be replaced with a safe adjuvant. The efficacy of purified protein derivatives (PPD) of Mycobacterium tuberculosis as pathogen-associated molecular patterns (PAMP) and a toll-like receptor (TLR) agonist [ 14 , 15 , 16 ] has not been established in digestive cancers.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency Combined with Intratumoral Immunotherapy: Preclinical Results and Safety in Metastatic Colorectal Carcinoma

Seguin,

El Hajjam,

Legagneux

et al. 2024

Pharmaceutics

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Radiofrequency ablation (RFA) of cancer induces an anti-tumor immunity, which is insufficient to prevent recurrences. In mice, RFA–intratumoral immunotherapy by granulocyte–macrophage colony-stimulating factor (GM-CSF) and Bacillus Calmette-Guerin resulted in complete metastases regression. Infectious risk in human needs replacement of live vaccines. Intratumoral purified protein derivatives (PPD) have never been tested in digestive cancers, and the safety of intratumoral immunotherapy after RFA has not yet been validated in human models. We investigated the therapeutic efficacy of combined radiofrequency ablation (RFA) and intratumoral immunotherapy (ITI) using an immune-muco-adherent thermogel (IMT) in a mouse model of metastatic colorectal cancer (CRC) and the safety of this approach in a pig model. Intratumoral stability of the immunogel was assessed using magnetic resonance imaging (MRI) and bioluminescent imaging. Seventy-four CT26 tumor-bearing female BALB/c mice were treated with RFA either alone or in combination with intratumoral IMT. Regression of distant metastasis and survival were monitored for 60 days. Six pigs that received liver radiofrequency and intralesional IMT injections were followed for 15 days. Experimental gel embolisms were treated using an intravascular approach. Pertinent rheology of IMT was confirmed in tumors, by the signal stability during 3 days in MRI and 7 days in bioluminescence imaging. In mice, the abscopal effect of RFA–intratumoral immunotherapy resulted in regression of distant lesions completed at day 16 vs. a volume of 350 ± 99.3 mm3 in the RFA group at day 25 and a 10-fold survival rate at 60 days. In pigs, injection of immunogel in the liver RFA area was safe after volume adjustment without clinical, hematological, and liver biology disorder. Flow cytometry showed an early increase in CD3 TCR+T cells at D7 (p < 0.05) and a late decrease in CD29+-CD8 T cells at D15 (p < 0.05), reflecting the inflammation status changes. Systemic GM-CSF release was not detectable. Experimental caval and pulmonary thermogel embolisms were treated by percutaneous catheterism and cold serum infusion. RFA–intratumoral immunotherapy as efficient and safe mini-invasive interventional oncology is able to improve ablative treatment of colorectal liver metastases.

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Disseminated Mycotic Aneurysms following Intravesical Bacillus Calmette–Guérin Therapy for Bladder Cancer: Case Discussion and Systematic Treatment Algorithm

Cited by 9 publications

References 18 publications

Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

Contiguous Mycotic Abdominal Aortic Aneurysm and Vertebral Osteomyelitis

Radiofrequency Combined with Intratumoral Immunotherapy: Preclinical Results and Safety in Metastatic Colorectal Carcinoma

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