BCG
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Renal tuberculosis: case report A 49-year-old man developed renal tuberculosis during treatment with BCG for non-muscle-invasive bladder cancer (NMIBC). The man had a medical history of NMIBC, for which he underwent transurethral resection previously. In October 2017, he had received two intravesicular instillations of BCG [strength not stated]. He once again underwent transurethral resection and received intravesical doxorubicin at the end of November 2017. Further, while receiving second round of BCG instillations, he experienced a nephrocolic episode, and macrohaematuria at fourth installation. Following fifth instillation, he developed fever measuring 39.1oC and lumbar pain indicating symptoms of dysuria. The man was treated with antibiotics; however, the symptoms did not show any response. He received isoniazid for his persisting fever, which resolved thereafter. He was referred to the current hospital, and his abdominal CT scan revealed multiple rounded hypodense masses of varying size in the left kidney, without any deformation and contrast enhancement in paranephric adipose tissue. A PCR test for Mycobacterium tuberculosis appeared positive. He was noted to have developed renal tuberculosis secondary to BCG instillations. He was initiated on four-drug regimen of isoniazid, rifampicin, pyrazinamide and ethambutanol, of which rifampicin and isoniazid were continued after 8 weeks of treatment. Subsequently, he showed significant improvement and was discharged thereafter. Author comment: "Despite its weakened state, BCG has the ability to become active and cause multisystem disease in treated patients." "[T]he treatment has some undesirable complications including ... severe systemic BCG sepsis..." Cheremisin D, et al. A case of renal tuberculosis following BCG therapy for bladder cancer. QJM - An International Journal of Medicine 112: 797-798, No. 10, Oct 2019. Available from: URL: http://doi.org/10.1093/qjmed/hcz188 803431776 Russia
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Reactions 9 Nov 2019 No. 1778
