Persistent Acid-Fast Bacilli Following Intravesical Bacillus Calmette-Guerin

Linn, Ran; Klimberg, Ira; Wajsman, Zev

doi:10.1016/s0022-5347(17)41212-2

Cited by 21 publications

(5 citation statements)

References 8 publications

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“…In 3 of these patients, acid-fast bacilli were demonstrated within the prostate. Linn et al reported the case of a patient who had undergone radical cysto-prostatectomy 1 year after BCG treatment failure [4], In this patient, acid-fast bacilli were found within the granulomas of the bladder, prostate and epididymis.…”

Section: Loco-regional Disseminationmentioning

confidence: 89%

BCG Therapy in Superficial Bladder Tumours - Complications and Precautions

Steg

Adjiman²,

Debré³

1992

Eur Urol

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Section: Loco-regional Disseminationmentioning

confidence: 89%

BCG Therapy in Superficial Bladder Tumours - Complications and Precautions

Steg

Adjiman²,

Debré³

1992

Eur Urol

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“…Introduction mentation of the prostate) within a year before the diagnosis of GP. Granulomatous inflammation of the prostate has been reported in some patients after receiving bacillus 4 No history of BCG instillation in the bladder, Wegener's granulomatosis, systemic vasculitis, or infec-Calmette-Guérin (BCG) therapy for bladder cancer [1,2], after transurethral resection of the prostate [3]…”

mentioning

confidence: 99%

Serum prostate specific antigen levels in non‐specific granulomatous prostatitis

Speights

Brawn

1996

British Journal of Urology

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“…Linn et al . [3] described granulomas of the bladder, prostate and epididymidis 1 year after BCG treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Persistence of BCG in urine or bladder biopsies more than 3 months after the last instillation is rare. There are, to our knowledge, only four published case reports with six patients who had a late BCG infection with inflammatory changes in the urinary bladder [3–6]. At cystoscopy, the bladder mucosa was described as either inflamed or showed scattered granulomas.…”

Section: Introductionmentioning

confidence: 98%

Late bacille Calmette–Guérin infection with a large focal urinary bladder ulceration as a complication of bladder cancer treatment

Ströck

Dotevall

Sandberg³

et al. 2010

BJU International

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Study Type – Therapy (case series)  Level of Evidence 4 What's known on the subject? and What does the study add? Intravesical BCG treatment has been used worldwide for many decades but there are only a few published reports on persisting BCG infection of the urinary bladder. This is the first report on large tuberculosis‐like ulcers of the urinary bladder after intravesical BCG treatment. The finding results in a recommendation to take urine cultures for mycobacteriae in patients with unclear inflammatory lesions in the bladder after instillation of BCG. OBJECTIVE To report a late bacille Calmette–Guérin (BCG) complication previously not described in the literature. PATIENTS AND METHODS We reviewed our database with 858 patients treated with BCG from 1986 to 2008 and identified 13 male patients (1.8% of all male patients) who had a large tuberculous‐like bladder ulcer. RESULTS All patients had high‐grade tumours and seven had tumours invading lamina propria before BCG treatment. A solitary ulceration or inflammatory lesion, 10–50 mm in diameter, was seen at routine follow‐up cystoscopy 2–34 months (median 8 months) after the first instillation. Significantly more patients had been treated with BCG‐RIVM than with BCG‐Tice (10/320 vs. three of 454, P < 0.01). BCG was cultured from urine 3–34 months (median 14 months) after the last instillation. So far, eight patients have been successfully treated with rifampicin and isoniazid. Nine patients are still tumour‐free 15–66 months (median 44 months) after the last transurethral resection before BCG treatment. Another three patients had one to two non‐invasive recurrences. One patient had an invasive recurrence and underwent cystectomy. The present study is limited by biases associated with its retrospective design. CONCLUSIONS This is the first report on persisting BCG infections with large inflammatory lesions in the bladder. Treatment is effective and the oncological outcome is good. Mycobacterial cultures of the urine should be performed in BCG‐patients with unclear inflammatory lesions in the bladder since a delayed diagnosis of a persistent BCG infection could result in a permanently reduced bladder capacity. Large studies are warranted to study differences in efficacy and side‐effects between different BCG strains.

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Persistent Acid-Fast Bacilli Following Intravesical Bacillus Calmette-Guerin

Cited by 21 publications

References 8 publications

BCG Therapy in Superficial Bladder Tumours - Complications and Precautions

BCG Therapy in Superficial Bladder Tumours - Complications and Precautions

Serum prostate specific antigen levels in non‐specific granulomatous prostatitis

Late bacille Calmette–Guérin infection with a large focal urinary bladder ulceration as a complication of bladder cancer treatment

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