BCG
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Tubercular abscesses following instillation in an elderly patient: case report An 83-year-old man developed abscesses after treatment with BCG for urothelial bladder cancer. The man presented with progressive symptoms for 3-month, with a 20kg weight loss and abdominal pain; he had been diagnosed with cancer 7 years earlier, had undergone transurethral resection and had received monthly instillations of BCG 81mg until 5 years before presentation [duration of treatment not stated]. On admission, abdominal ultrasound and CT scans revealed a right psoas abscess, a collection next to his uncinate process of the pancreas and a second collection left paraaortic. Laboratory investigations were only remarkable for an ESR of 73 mm/h and a CRP level of 9.46 µg/dL. A pyogenic retroperitoneal abscess was suspected. The man received empirical meropenem and teicoplanin. Cultures and a Mantoux test were negative. A CT-guided puncture of the right psoas abscess yielded only 30mL of pus, and a culture did not grow any bacteria. He then underwent right lumbotomy with extraction of a large amount of pus, and alcohol-resistant bacilli became evident. Tuberculosis was suspected, and he began receiving rifampicin, isoniazid and ethambutol. BCG-type Mycobacterium bovis was confirmed by L¨ owenstein culture. He was discharged with a 12-month course of antituberculars; however, an open right lumbar fistula draining sterile pus persisted. Fernandez JM, et al. Abdominal and retroperitoneal abscesses in a patient with bladder carcinoma receiving BCG therapy. Enfermedades Infecciosas Y Microbiologia Clinica 27: 485-6, No. 8, Oct 2009 [Spanish; summarised from a 803008394 translation.] - Spain
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Reactions 20 Mar 2010 No. 1293
