Bacillus Calmette-Guerin İmmünoterapisi Sonrası Gelişen Ölümcül Sistemik Komplikasyonlar: Olgu Sunumu

Öz

Mesanenin değişici epitel karsinomlarının yaklaşık %70’ini kasa invaze olmayan mesane kanserleri oluşturur ve bu kanserlerde Bacillus Calmette-Guerin (BCG) tedavi ve nüksü önlemek için profilaktik olarak uygulanmaktadır. Bu uygulama genel olarak güvenilir kabul edilmekte ve nadiren sistemik komplikasyonlara neden olmaktadır. Biz bu yazıda mesane karsinomu nedeniyle transüretral rezeksiyon uygulanan ve daha sonra intravezikal BCG immünoterapisi başlanan hastada 5. kür BCG uygulanmasından sonra hipersensitivite reaksiyonu, tuberküloz sepsisi, akut böbrek yetmezliği, DIC, metebolik asidoz gelişen ve eş zamanlı pulmoner emboli saptanan olguyu sunmak istedik.

Anahtar Kelimeler

• Bacillus Calmette-Guerin, sistemik komplikasyonlar, mesane kanserleri

Fatal Systemic Complications after Bacillus Calmette-Guérin Immunotherapy: A Case Report

Öz

Approximately 70% of bladder transitional epithelium cell carcinomas are non-invasive muscular bladder cancers, and for the treatment and prevention of recurrence of this type of cancer, Bacillus Calmette-Guerin (BCG) is applied prophylactically. This practice is generally considered reliable and rarely causes systemic complications. We present here a case in which the patient underwent transurethral resection due to bladder carcinoma and subsequently received intravesical BCG immunotherapy. After the fifth application of BCG, hypersensitivity, tuberculosis sepsis, acute kidney injury, DIC, metabolic acidosis and simultaneous pulmonary embolism were observed

Anahtar Kelimeler

• Bacillus Calmette-Guerin, systemic complications, vesical carcinomas

Kaynakça

1. Thevenot T, Martino V DI, Largange A, Petrella T, Faucher JF, Fontan J, et al. Granulomatous hepatitis and hemophagocytic syndrome after ba- cillus Calmette-Guerin bladder instillation. Gastroenterol Clin Biol 2006; 30: 480-2. [CrossRef]
2. Soyupak B. Kasa invaze olmayan ‘yüzeyel’ mesane kanserlerinde Bacille Calmette-Guerin (BCG) tedavisi ve prognoz. Ozen H, Turkeri L Uroonko- loji Kitabı. 1. Baskı. Ankara, Ertem Basım Yayın; 2007: 242-57.
3. Leebeek FW, Ouwendijk RJ, Kolk AH, Dees A, Meek JC, NienhuisJE, et al. Granulomatous hepatitis caused by bacillus Calmette-Guerin (BCG) infection after BCG bladder instillation. Gut 1996; 38: 616-8. [CrossRef]
4. Durek C, Jurczok A, Werner H, Jocham D, Bohle A. Optimal treatment of systemic bacillus Calmette-Guerin infection: investigations in an animal model. J Urol 2002; 168: 826-31. [CrossRef]
5. Orihuela E, Herr HW, Pinsky CM, Whitmore WF Jr. Toxicity of intravesical BCG and its management in patients with superficial bladder tumors. Cancer 1987; 60: 326-33. [CrossRef]
6. Nadasy KA, Patel RS, Emmett M, Murillo RA, Tribble MA, Black RD, et al. Four cases of disseminated Mycobacterium bovis infection following intravesical BCG instillation for treatment of bladder carcinoma. South Med J 2008; 101: 91-5. [CrossRef]
7. Manzanera EMJ, Morales Ruiz E, Odriozola GM, Gutierrez ME, Rodriquez AA, Praga TM. Acute renal failure due to interstitial nephritis after intra- vesical instillation of BCG. Clin Exp Nephrol 2007; 11: 238-40. [CrossRef]
8. Fry A, Saleemi A, Griffiths M, Farrington K. Acute renal failure following int- ravesical bacille Calmette-Guérin chemotherapy for superficial carcino- ma of the bladder. Nephrol Dial Transplant 2005; 20: 849-50. [CrossRef]

9. Lamm DL, Steg A, Boccon-Gibod L, Morales A, Hanna MG Jr, Pagano F, et al. Complications of bacillus Calmette-Guerin immunotherapy: revi- ew of 2602 patients and comparison of chemotherapy complications. Prog Clin Biol Res 1989; 310: 335-55.
10. Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequ- ency, risk factors and trends for venous thromboembolism among hos- pitalized cancer patients. Cancer 2007; 110: 2339-46. [CrossRef]