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Transüretral Mesane Tümörü Rezeksiyonu Sonrası Bacillus Calmette-Guérin Bcg İmmünoterapisine Bağlı Nadir Bir Komplikasyon: Akut Solunum Yetmezliği ve Sepsis

Year 2018, Volume: 28 Issue: 4, 168 - 172, 01.12.2018

Faruk Çiçekci Mustafa Büyükcavlak Yeşim Şerife Bayraktar Jale Bengi Çelik

Abstract

Yüzeyel mesane kanserinde intravezikal BCG tedavisi güvenli ve etkili olarak kabul edilir. Sistemik komplikasyonlar nadir de olsa fark edilmediğinde yaşamı tehdit edici olabilir. Bu olgu sunumunda, intravezikal BCG tedavisinden sonra sistemik enfeksiyonun erken ve etkili tedavisinin önemini vurgulamak istedik.Olgu: 52 yaşında yüzeyel mesane kanseri teşhisi konulan ve 4 kez Trans Uretral Rezeksiyon-Mesane Tümörü TUR-MT operasyonu uygulanan erkek hastaya BCG tedavisi planlanmış. BCG'nin üçüncü kür tedavisinden 2 hafta sonra, hasta yüksek ateş, kırıklık, solunum sıkıntısı nedeniyle yoğun bakım ünitesine yatırıldı. Hastayahemen anti-tüberküloz tedavisi başlandı. Yoğun bakım ünitesinde genel durumu bozulan hasta mekanik ventilatöre bağlandı. Hastada pozitif inotropik tedaviye cevap vermeyen hipotansiyon ile birlikte akut böbrek yetmezliği gelişti ve hemodiyaliz tedavisi başlandı. Ancak 23. günde, kardiyak arrest geçiren hasta tüm müdahalelerecevap vermedi ve eksitus oldu.Sonuç: BCG tedavisinin sistemik yan etkileri nadirdir, ancak hızlı ve etkin bir şekilde tedavi edilmezse yaşamı tehdit eder. Bu nedenle, BCG tedavisinden sonra ateş, taşikardi gibi sistemik bulgular görüldüğünde, anti-tüberküloz tedavisi hızla başlatılmalıdır. Kortikosteroidlerin tedaviye eklenmesi yapılan çalışmalarda önerilmektedir

Keywords

Bacillus calmette-guérin ransuretral rezeksiyon mesane tümörü akut akciğer yetmezliği sepsis

References

  • El-Demiry MI, Smith G, Ritchie AW, et al. Local immune responses after intravesical BCG treatment of carcinoma in situ. Br J Urol 1987; 60: 543-8.
  • Böhle A, Gerdes J, Ulmer AJ, et al. Effects of local bacillus Calmette-Guérin therapy in patients with bladder carcino- ma on immunocompetent cells of the bladder wall. J Urol 1990; 144: 53-8.
  • Lamm DL. Efficacy and safety of bacillus Calmette±Guerin immunotherapy in superficial bladder cancer. Clin Infect Dis 2000; 31: 86-90.
  • Leebeek FW, Ouwendijk RJ, Kolk AH, Dees A, Meek JC, Nienhuis JE, et al. Granulomatous hepatitis caused by Ba- cillus Calmette-Guérin (BCG) infection after BCG bladder instillation. Gut 1996; 38: 616-8.
  • Gonzalez OY, Musher DM, Brar I, Furgeson S, Boktour MR, Septimus EJ, et al. Spectrum of bacille Calmette-Gué- rin (BCG) infection after intravesical BCG immunothe- rapy. Clin Infect Dis 2003; 36: 140-8.
  • Soylu A, Ince AT, Polat H, Yasar N, Ciltas A, Ozkara S, et al. Peritoneal tuberculosis and granulomatous hepatitis se- condary to treatment of bladder cancer with bacillus Cal- mette-Guérin. Ann Clin Microbiol Antimicrob 2009; 8: 12.
  • Ersoy O, Aran R, Aydinli M, Yonem O, Harmanci O, Akdo- gan B, et al. Granulomatous hepatitis after intravesical BCG treatment for bladder cancer. Indian J Gastroenterol 2006; 25: 258-9.
  • Lamm DL. Complications of Bacillus Calmette–Guérin im- munotherapy. Urol Clin North Am 1992;19:565-72.
  • Rival G, Garot D, Mercier E, et al. Acute respiratory fai- lure and septic shock induced by Mycobacterium bovis. A rare side effect of intravesical BCG therapy. Presse Med 2006;35:980.
  • Alzeer AH, FitzGerald JM. Corticosteroids and tuberculo- sis: risks and use as adjunct therapy. Tuberc Lung Dis 1993; 74:6-11.
  • Dooley DP, Carperter JL, Rademacher S. Adjunctive corti- costeroid therapy for tuberculosis: a critical reappraisal of the literature. Clin Infect Dis 1997; 25:872-87.
  • Grange JM. Complications of bacille Calmette–Guérin (BCG) vaccination and immunotherapy and their manage- ment. Commun Dis Public Health 1998;1:84–8.
  • Nadasy KA, Patel RS, Emmett M, et al. Four cases of disse- minated Mycobacterium bovis infection following intrave- sical BCG instillation for treatment of bladder carcinoma. South Med J 2008;101:91-5.
  • Soylu A, Ince AT, Polat H, et al. Peritoneal tuberculosis and granulomatous hepatitis secondary to treatment of bladder cancer with bacillus Calmette-Guérin. Ann Clin Microbiol Antimicrob 2009; 8: 12.
  • Lamm DL, van der Meijden PM, Morales A, et al. Incidence and treatment of bacillus Calmette-Guérin intravesical the- rapy in superficial bladder cancer. J Urol 1992;147:596-600.
  • Paterson DL, Patel A. Bacillus Calmette-Guerin (BCG) im- munotherapy for bladder cancer: Review of complications and their treatment. Aust NZJ Surg 1998; 68: 340-4.
  • Steg A, Adjiman S, Debre B. BCG therapy in superficial bladder tumours- complications and precautions. Eur Urol 1992; 21: 35-40.
  • Martinez-Piñeiro JA, Flores N, Isorna S, et al. Long-term follow-up of a randomized prospective trial comparing a standard 81 mg dose of Intravesical bacilli Calmette-Guérin with a reduced dose of 27 mg in superficial bladder cancer. BJU Int 2002; 89: 671-80.
  • Koga H, Kuroda M, Kudo S, et al. Adverse drug reactions of intravesical bacillus Calmette-Guérin instillation and risk factors of the development of adverse drug reactions in su- perficial cancer and carcinoma in situ of the bladder. Int J Urol 2005; 12: 145-51.
  • Irie A, Uchida T, Yamashita H, et al. Sufficient prophylactic efficacy with minor adverse effects by intravesical instilla- tion of low-dose bacillus Calmette-Guérin for superficial bladder cancer recurrence. Int J Urol 2003; 10: 183-9.
  • Lamm DL, Stogdill VD, Stogdill BJ, Crispen RG. Complica- tions of bacillus Calmette-Guérin immunotherapy in 1278 patients with bladder cancer. J Urol 1986; 135: 272-4.

Year 2018, Volume: 28 Issue: 4, 168 - 172, 01.12.2018

Faruk Çiçekci Mustafa Büyükcavlak Yeşim Şerife Bayraktar Jale Bengi Çelik

Abstract

Intravesical Bacillus Calmette-Guérin BCG therapy in superficial bladder cancer is considered safe and effective. Systemic complications, although rare, can be life-threatening if not noticed. In this case, we wanted to emphasize the importance of early and effective treatment of systemic infection after intravesical BCG therapy.Case: A 52-year-old male patient was diagnosed with superficial bladder cancer. He had four times Trans Urethral Resection-Bladder Tumor TUR-BT operation. Two weeks after the third cure of BCG, the patient was admitted to intensive care unit due to high fever, malaise, respiratory distress. The patient was immediately treated with anti-tuberculosis treatment.In the intensive care unit, the patient whose general condition was disrupted was connected to the mechanical ventilator. Positive inotropic treatment resistant hypotension, acute renal failure occurred. Hemodialysis treatment started. But, on the 23th day the patient who had undergone cardiac arrest and did not respond to the intervention was considered to exitus.Conclusion: Systemic side effects of BCG therapy are rare but life threatening if not treated quickly and effectively. Therefore, when systemic findings such as fever, tachycardia are seen after BCG treatment, anti-tuberculosis treatment should be started quickly.The addition of corticosteroids to the treatment is recommended in studies

Keywords

Bacillus calmette-guérin transurethral resection bladder tumor acut respiratory failure sepsis

References

  • El-Demiry MI, Smith G, Ritchie AW, et al. Local immune responses after intravesical BCG treatment of carcinoma in situ. Br J Urol 1987; 60: 543-8.
  • Böhle A, Gerdes J, Ulmer AJ, et al. Effects of local bacillus Calmette-Guérin therapy in patients with bladder carcino- ma on immunocompetent cells of the bladder wall. J Urol 1990; 144: 53-8.
  • Lamm DL. Efficacy and safety of bacillus Calmette±Guerin immunotherapy in superficial bladder cancer. Clin Infect Dis 2000; 31: 86-90.
  • Leebeek FW, Ouwendijk RJ, Kolk AH, Dees A, Meek JC, Nienhuis JE, et al. Granulomatous hepatitis caused by Ba- cillus Calmette-Guérin (BCG) infection after BCG bladder instillation. Gut 1996; 38: 616-8.
  • Gonzalez OY, Musher DM, Brar I, Furgeson S, Boktour MR, Septimus EJ, et al. Spectrum of bacille Calmette-Gué- rin (BCG) infection after intravesical BCG immunothe- rapy. Clin Infect Dis 2003; 36: 140-8.
  • Soylu A, Ince AT, Polat H, Yasar N, Ciltas A, Ozkara S, et al. Peritoneal tuberculosis and granulomatous hepatitis se- condary to treatment of bladder cancer with bacillus Cal- mette-Guérin. Ann Clin Microbiol Antimicrob 2009; 8: 12.
  • Ersoy O, Aran R, Aydinli M, Yonem O, Harmanci O, Akdo- gan B, et al. Granulomatous hepatitis after intravesical BCG treatment for bladder cancer. Indian J Gastroenterol 2006; 25: 258-9.
  • Lamm DL. Complications of Bacillus Calmette–Guérin im- munotherapy. Urol Clin North Am 1992;19:565-72.
  • Rival G, Garot D, Mercier E, et al. Acute respiratory fai- lure and septic shock induced by Mycobacterium bovis. A rare side effect of intravesical BCG therapy. Presse Med 2006;35:980.
  • Alzeer AH, FitzGerald JM. Corticosteroids and tuberculo- sis: risks and use as adjunct therapy. Tuberc Lung Dis 1993; 74:6-11.
  • Dooley DP, Carperter JL, Rademacher S. Adjunctive corti- costeroid therapy for tuberculosis: a critical reappraisal of the literature. Clin Infect Dis 1997; 25:872-87.
  • Grange JM. Complications of bacille Calmette–Guérin (BCG) vaccination and immunotherapy and their manage- ment. Commun Dis Public Health 1998;1:84–8.
  • Nadasy KA, Patel RS, Emmett M, et al. Four cases of disse- minated Mycobacterium bovis infection following intrave- sical BCG instillation for treatment of bladder carcinoma. South Med J 2008;101:91-5.
  • Soylu A, Ince AT, Polat H, et al. Peritoneal tuberculosis and granulomatous hepatitis secondary to treatment of bladder cancer with bacillus Calmette-Guérin. Ann Clin Microbiol Antimicrob 2009; 8: 12.
  • Lamm DL, van der Meijden PM, Morales A, et al. Incidence and treatment of bacillus Calmette-Guérin intravesical the- rapy in superficial bladder cancer. J Urol 1992;147:596-600.
  • Paterson DL, Patel A. Bacillus Calmette-Guerin (BCG) im- munotherapy for bladder cancer: Review of complications and their treatment. Aust NZJ Surg 1998; 68: 340-4.
  • Steg A, Adjiman S, Debre B. BCG therapy in superficial bladder tumours- complications and precautions. Eur Urol 1992; 21: 35-40.
  • Martinez-Piñeiro JA, Flores N, Isorna S, et al. Long-term follow-up of a randomized prospective trial comparing a standard 81 mg dose of Intravesical bacilli Calmette-Guérin with a reduced dose of 27 mg in superficial bladder cancer. BJU Int 2002; 89: 671-80.
  • Koga H, Kuroda M, Kudo S, et al. Adverse drug reactions of intravesical bacillus Calmette-Guérin instillation and risk factors of the development of adverse drug reactions in su- perficial cancer and carcinoma in situ of the bladder. Int J Urol 2005; 12: 145-51.
  • Irie A, Uchida T, Yamashita H, et al. Sufficient prophylactic efficacy with minor adverse effects by intravesical instilla- tion of low-dose bacillus Calmette-Guérin for superficial bladder cancer recurrence. Int J Urol 2003; 10: 183-9.
  • Lamm DL, Stogdill VD, Stogdill BJ, Crispen RG. Complica- tions of bacillus Calmette-Guérin immunotherapy in 1278 patients with bladder cancer. J Urol 1986; 135: 272-4.
There are 21 citations in total.

Details

Primary Language Turkish
Journal Section Case Report
Authors

Faruk Çiçekci This is me

Mustafa Büyükcavlak This is me

Yeşim Şerife Bayraktar This is me

Jale Bengi Çelik This is me

Publication Date December 1, 2018
Published in Issue Year 2018 Volume: 28 Issue: 4

Cite

Vancouver Çiçekci F, Büyükcavlak M, Bayraktar YŞ, Çelik JB. Transüretral Mesane Tümörü Rezeksiyonu Sonrası Bacillus Calmette-Guérin Bcg İmmünoterapisine Bağlı Nadir Bir Komplikasyon: Akut Solunum Yetmezliği ve Sepsis. Genel Tıp Derg. 2018;28(4):168-72.

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