Long-term, real world experience of ventricular tachycardia and granulomatous cardiomyopathy

Bohora, Shomu; Mumtaz, Zeeshan; Phadke, Milind; Bhute, Vishnu; Bhatia, Varun; Vora, Amit; Naik, Ajay; Nabar, Ashish; Jankharia, Bhavin; Vaideeswar, Pradeep; Panicker, Gopi Krishna; Lokhandwala, Yash

doi:10.1016/j.ipej.2022.04.001

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…They are known to cause ventricular tachycardia and arrythmias. (25) To our best knowledge, BCG therapy causing cardiac granulomas is extremely rare and has not been reported before.…”

Section: Discussionmentioning

confidence: 98%

Granulomatous Myocarditis Arising from Intravesical Bacillus Calmette-Guerin (BCG) Therapy Leading to Death Diagnosed by Post-Mortem Examination

Geetha

Chavarria

Abdelwahed

et al. 2023

Preprint

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Background: Intravesical Bacillus Calmette-Guerin (BCG) is used as a standard adjuvant therapy for non-muscle invasive urothelial cancer. Most patients tolerate the treatment well, with mild side effects. Systemic complications are extremely rare, occur due to BCG dissemination and are associated with immunocompromised state and urothelial breach. Case presentation: We present a case of a 78-year-old male, a former smoker, with history of non-invasive urothelial carcinoma status post partial resection followed by intravesical BCG therapy. An autopsy was performed due to the sudden nature of his death. Autopsy showed multiple necrotizing granulomas in the brain, atrium, ventricles, lungs, kidneys, and urinary bladder. Stains for acid fast bacilli and fungi were negative. In addition, bilateral lungs showed evidence of bronchopneumonia secondary to cytomegalovirus. Conclusion: Granulomatous myocarditis arising from BCG therapy is extremely rare. Our patient with urothelial cancer treated with BCG developed multi organ granulomas, most likely due to a hypersensitivity reaction to intravesical BCG. Arrhythmia induced by granulomatous myocarditis was the cause of his death. Though there have been few cases of systemic BCG-osis causing fatal sepsis leading to death, a cardiac cause of death is unique.

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“…They are known to cause ventricular tachycardia and arrythmias. (25) To our best knowledge, BCG therapy causing cardiac granulomas is extremely rare and has not been reported before.…”

Section: Discussionmentioning

confidence: 98%

Granulomatous Myocarditis Arising from Intravesical Bacillus Calmette-Guerin (BCG) Therapy Leading to Death Diagnosed by Post-Mortem Examination

Geetha

Chavarria

Abdelwahed

et al. 2023

Preprint

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show abstract

“…Granulomatous cardiomyopathy is a rare entity and can be seen in tuberculosis infection. They are known to cause ventricular tachycardia and arrhythmias [ 20 ]. To our best knowledge, BCG therapy causing cardiac granulomas is extremely rare and has not been reported before.…”

Section: Discussionmentioning

confidence: 99%

Granulomatous myocarditis arising from intravesical Bacillus Calmette–Guérin therapy leading to death diagnosed by postmortem examination: a case report

Geetha,

Chavarria,

Abdelwahed

et al. 2024

J Med Case Reports

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Background Intravesical Bacillus Calmette–Guérin (BCG) is used as a standard adjuvant therapy for non-muscle invasive urothelial cancer. Most patients tolerate the treatment well, with mild side effects. Systemic complications are extremely rare, occur due to BCG dissemination and are associated with immunocompromised state and urothelial breach. Case presentation We present a case of a 78-year-old male, a former smoker, with history of non-muscle invasive urothelial carcinoma status post partial resection followed by intravesical BCG therapy. An autopsy was performed due to the sudden nature of his death. Autopsy showed multiple necrotizing granulomas in the brain, atrium, ventricles, lungs, kidneys, and urinary bladder. Stains for acid-fast bacilli and fungi were negative. In addition, bilateral lungs showed evidence of bronchopneumonia secondary to cytomegalovirus. Conclusion Granulomatous myocarditis arising from BCG therapy is extremely rare. Our patient with urothelial cancer treated with BCG developed multiorgan granulomas, most likely due to a hypersensitivity reaction to intravesical BCG. Arrhythmia induced by granulomatous myocarditis was the cause of his death. Although there have been few cases of systemic BCG-osis causing fatal sepsis leading to death, a cardiac cause of death is unique.

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“…(i)Cardiac tuberculosis features prominently in the differential diagnosis of cardiac sarcoidosis because it is a highly prevalent granulomatous disorder, and can involve the myocardium, giving rise to VT [11] , [12] , CHB [13] , sudden death [14] , [15] , and CHF [16] , [17] , respectively. Pericarditis [18] , and endocarditis [19] , respectively, are also manifestations of cardiac tuberculosis.…”

Section: Differential Diagnosis Of Cardiac Sarcoidosis ( Ta...mentioning

confidence: 99%

High-risk and low prevalence disease: Cardiac sarcoidosis and some of its mimics

Jolobe

2023

IJC Heart & Vasculature

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Long-term, real world experience of ventricular tachycardia and granulomatous cardiomyopathy

Cited by 4 publications

References 21 publications

Granulomatous Myocarditis Arising from Intravesical Bacillus Calmette-Guerin (BCG) Therapy Leading to Death Diagnosed by Post-Mortem Examination

Granulomatous Myocarditis Arising from Intravesical Bacillus Calmette-Guerin (BCG) Therapy Leading to Death Diagnosed by Post-Mortem Examination

Granulomatous myocarditis arising from intravesical Bacillus Calmette–Guérin therapy leading to death diagnosed by postmortem examination: a case report

High-risk and low prevalence disease: Cardiac sarcoidosis and some of its mimics

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