BCG
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Tuberculous prostatic abscess: case report A 57-year-old man developed tuberculous prostatic abscess while receiving immunotherapy with BCG for urothelial carcinoma. The man, who had urothelial carcinoma, started receiving immunotherapy with intravesical BCG for 6 weeks at a concentration of 120mg in 50mL sodium chloride [saline]. He did not have any history of tuberculosis. Following 6 weeks of BCG treatment, he experienced perineal discomfort. A digital rectal examination revealed tenderness, which was suspicious for infection in the left lobe of the prostate. Microscopic urine analysis showed few red blood cells. The level of total prostatespecific antigen was 2.61 ng/mL and the free prostate-specific antigen was 0.23 ng/mL. An MRI showed hypo-intense lesion on T2-weighted imaging (T2WI) and hyper-intensity on diffusion-weighted imaging in the peripheral zone of the left prostate gland. Findings of prostate biopsy and a subsequent histology of this hypo-intense lesion were significant for granulomatous prostatitis. PCR was found to be positive for tuberculosis in only the prostate. Based on these findings, he was diagnosed with tuberculous prostatic abscess. The man received anti-tubercular treatment with isoniazid, rifampicin and ethambutol for 9 months. Following a month of treatment, his symptoms improved and after completion of 9 months anti-tubercular treatment, a follow-up MRI revealed disappearance of the prostatic abscess. A recent cystoscopy had revealed no signs of tumour recurrence and no inflammation of the prostate. Author comment: "[Immunotherapy with BCG] is generally safe but has rare complications of tuberculous infection in the prostate, which can occur via hematogenous spreading and through direct extension of the infection." Wang B, et al. Tuberculous prostatic abscess following intravesical bacillus Calmette-Guerin immunotherapy. Chinese Medical Journal 132: 2263-2264, No. 18, 20 Sep 2019. Available from: URL: http://doi.org/10.1097/ 803433544 CM9.0000000000000414 - China
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Reactions 16 Nov 2019 No. 1779
