Mycobacterium Bovis Infection of an Axillary-Femoral Bypass Graft after Intravesical Bacille Calmette-Guérin Immunotherapy for Bladder Cancer

Shakir, Faiz; Dang, V.; Bronze, Michael S.; Liu, Cheng; Machado, Linda J.

doi:10.1097/01.maj.0000308884.50320.8a

Cited by 10 publications

(3 citation statements)

References 12 publications

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“…We have identified 19 cases of vascular complication following intravesical BCG instillations, most of them in form of mycotic aneurysm or pseudoaneurysm 17 , 34 , 35 , 83 , 87 , 173 – 175 , 183 , 227 or infection of vascular prosthetic grafts. 183 , 187 This form of disease may occur either by hematogenous seeding of the vasa vasorum of the arterial wall or as a result of direct extension from a contiguous infected site, typically spondylodiscitis 36 or perivascular lymph nodes. 67 , 183 The vascular infection often follows a protracted course with low-grade fever, malaise and weight loss 83 , 126 ; the median time interval between the previous instillation and the diagnosis was 16.7 months in our review.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…There has been only one case report in the literature of M. bovis infection of an axillary-femoral bypass graft following intravesical BCG therapy [10]. This patient was a 62 year old male with noninvasive urothelial carcinoma who received BCG instillations over a 10 month period.…”

Section: Discussionmentioning

confidence: 99%

“…This patient was a 62 year old male with noninvasive urothelial carcinoma who received BCG instillations over a 10 month period. He underwent removal of the bypass graft and received isoniazid, rifampin, and ethambutol for 9 months [10]; however, there was no follow-up available for their patient. Our patient underwent surgical removal of the entire axillo-bifemoral bypass graft except there was a small rim of incorporated graft.…”

Section: Discussionmentioning

confidence: 99%

Infection of an axillo-bifemoral bypass graft following intravesical bacillus Calmette–Guerin (BCG) immunotherapy for urothelial cancer due to Mycobacterium bovis and Staphylococcus aureus

DeSimone

Tande

2016

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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We report a case of occult Mycobacterium bovis left axillary-bifemoral bypass graft infection, with superimposed acute methicillin-susceptible Staphylococcus aureus (MSSA) infection in an 82 year old male following intravesicular bacillus Calmette–Guerin (BCG) for adjuvant therapy of urothelial cancer. The patient underwent partial removal of the bypass graft and treated with antimycobacterial therapy—rifampin and isoniazid for 9 months, and intravenous cefazolin followed by oral cephalexin for chronic suppressive therapy for MSSA. This presentation highlights the need to consider indolent infection masquerading as mechanical erosion, even when an alternate infection is present.

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Mycobacterium bovis infection of an aortobifemoral bypass graft with Streptococcus intermedius superinfection after intravesical bacillus Calmette-Guérin immunotherapy for bladder cancer

Dubert

Abihssira

Diamantis³

et al. 2020

Infection

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Mycobacterium Bovis Infection of an Axillary-Femoral Bypass Graft after Intravesical Bacille Calmette-Guérin Immunotherapy for Bladder Cancer

Cited by 10 publications

References 12 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

Infection of an axillo-bifemoral bypass graft following intravesical bacillus Calmette–Guerin (BCG) immunotherapy for urothelial cancer due to Mycobacterium bovis and Staphylococcus aureus

Mycobacterium bovis infection of an aortobifemoral bypass graft with Streptococcus intermedius superinfection after intravesical bacillus Calmette-Guérin immunotherapy for bladder cancer

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