Ruptured mycotic abdominal aortic aneurysm secondary to Mycobacterium bovis after intravesical treatment with bacillus Calmette-Guérin

Abstract

Bacillus Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis that has proven effective in the treatment of early-stage bladder cancer. Although intravesical therapy with BCG is generally considered safe, serious complications including hematuria, granulomatous pneumonitis, hepatitis, and life-threatening BCG sepsis are well known. BCG-related vascular infections are rarely reported. We present a case of a ruptured abdominal aortic aneurysm secondary to M bovis infection 2 years after intravesical instillation of BCG and review the related literature.

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

“…Our review highlights that several in situ prosthetic conduits 6,7,11,13,15,21,22,24 and one stent graft 8 were used without any infectious complication when combined with antituberculous medications. In our patient, we used an in situ prosthetic graft for the left carotid artery because the aneurysm etiology was unknown at the time of the repair.…”

“…[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.…”

“…It was positive in all but one reported case. 8 Other diagnostic tests with lower specificity were also reported and include direct acid-fast bacilli detection, [6][7][8][9][10][11][12]14,15,17,18,[20][21][22][23][24] evidence of typical caseating granulomatous lesions, 6,7,9,13,[17][18][19][20][21][22][23] and PCR 10,18 from various tissue samples.…”

Hépatite granulomateuse révélant une infection disséminée à Mycobacterium bovis après BCG-thérapie intravésicale

“…La littérature fait état de plusieurs observations d'atteintes diffuses par la BCG, ou BCGites généralisées. Les principales localisations décrites sont celles retrouvées chez notre patient et concernent les poumons, le foie, l'aorte, les articulations périphériques et le rachis (spondylodiscite), l'oeil, la moelle osseuse [7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Infected Aortic Aneurysms

“…Mycobacterium species could also result in infected aortic aneurysms [59,60], while Bacillus Calmette-Guérin-related abdominal aorta infection has also been reported in Ref. [61].…”