Journal des maladies infectieuses et de la pathologie

Abstrait

Disseminated BCG Infection after Intravesical Instillation in Bladder Cancer: Early Recognition and Prompt Treatment

Marco Distefano

Intravesical administration of Bacillus Calmette-Guérin delay tumor progression, decrease the need for cystectomy, and improve overall survival of non-muscle invasive bladder cancer. In immunocompetent patients, iBCG is usually well tolerated; but uncommonly, severe local and systemic complications can occur. Definitive diagnosis of BCG infection requires M. bovis BCG culture (of bodily fluids or tissue from involved sites) but the fastidious growth nature of BCG in culture and a doubling time of 24 to 48 hours contribute to the difficulty in its isolation. On suspicion of a systemic disease due to BCG, antituberculous therapy should be initiated. There are no clinical trials and no official guidelines regarding treatment, but as M. bovis is usually resistant to pyrazinamide and cycloserine, a regimen that includes isoniazid, rifampicin, ethambutol and a fluoroquinolone, such as levofloxacin, is usually administered for at least 6 months. In the setting of extensive miliary involvement and/or respiratory failure, the concomitant administration of glucocorticoids given the potential role of hypersensitivity in the pathogenesis of the disease, has been associated with clinical improvement in case reports.