Mycotic Aneurysm of the Popliteal Artery as a Complication of Intravesical BCG Therapy for Superficial Bladder Cancer

Abstract

A 67-year-old man was treated with maintenance intravesical BCG for superficial bladder cancer. As a culture-proven complication of this therapy, he developed general malaise, high fever, granulomatous hepatitis and a mycotic aneurysm in his left knee. All complications were treated successfully with antituberculous therapy. No vascular surgery was necessary. This case report again stresses the necessity to recognise complications of BCG treatment and to start adequate therapy as soon as possible.

Multiple mycotic aneurysms due to Mycobacterium bovis after intravesical bacillus Calmette-Guérin therapy

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Mean age at diagnosis was 72 years (range, 58-80 years), and aneurysms were diagnosed a mean of 23 months (range, 4-69 months) after BCG therapy. Episodes of fever or fatigue during or immediately after BCG instillations were reported by 11 patients (52%), but were absent in our patient.…”

“…The most frequent clinical symptoms at presentation were abdominal or back pain in 12 (57%), general malaise in 11 (52%), fever in 8 (38%), and pulsatile or painful mass in 4 (19%). The abdominal aorta was involved in 16 patients (76%), but aneurysms of the aortic arch, 9 the femoral arteries, 7,16,19,24 the popliteal artery, 15,20 and the carotid artery 17 were also reported. Similar to our patient, 11 patients (52%) presented with rupture, with histologic finding of arterial wall necrosis in most.…”

Complications of Intravesical Bacillus Calmette-Guérin

“…[47][48][49][50] Unlike other complications, the tissue specimens in these cases are universally positive for AFB when appropriate identification methods are used. BCG vasculitis has involved large arteries such as the aorta and popliteal artery leading to mycotic aneurysms and rupture.…”

Mycobacterium tuberculosis Culture Supernatant Induces Cancer Cell Apoptosis and Cell Cycle Arrest

“…The idea that mycobacteria could be used to treat human cancer has a long history. The first mycobacterium reported to have anti-tumor activity was BCG (derived from M. bovis, a member of the M. tuberculosis complex) [19], which is now widely used to treat human superficial bladder cancer [20,21]. It is thought that BCG might regulate human immune function and stimulates T lymphocytes to secrete cytokines (such as tumor necrosis factors, TNF) or other factors, which then kill tumor cells through a non-specific stander-by mechanism [21].…”

“…The first mycobacterium reported to have anti-tumor activity was BCG (derived from M. bovis, a member of the M. tuberculosis complex) [19], which is now widely used to treat human superficial bladder cancer [20,21]. It is thought that BCG might regulate human immune function and stimulates T lymphocytes to secrete cytokines (such as tumor necrosis factors, TNF) or other factors, which then kill tumor cells through a non-specific stander-by mechanism [21]. However, it is interesting to note that BCG is only effective in treating superficial surface located bladder cancer but not non-surface located bladder cancer, suggesting that BCG may also have direct effect on cancer cells besides its immunostimulatory role.…”