A Rare Case Seen in a Patient with Intravesical Bacillus Calmette-Guerin (BCG) Intolerance: Autoimmune Myopathy

Öz

Aim: We present a case of autoimmune myopathy observed in a patient who developed intolerance to intravesical Bacillus Calmette-Guerin (BCG), which is used in the treatment of non-muscle invasive bladder cancer. Case: Intravesical BCG, which is used for the treatment of non-muscle invasive bladder cancer, probably effects by increasing autoimmunity in the bladder. This increased autoimmunity sometimes causes local or systemic reactions. In this case report, we would like to present a 61-year-old male patient who developed intolerance while taking the first dose of maintenance BCG, and then on-going treatment was stopped. The patient had convulsive painful cramps and muscle twitches in the left quadriceps femoris region one month later BCG intolerance. When the patient’s anamnesis, electromyography (EMG) results, elevated Creatine Kinase value and other laboratory data were evaluated together, BCG triggered autoimmune myopathy was considered. Therefore, steroid treatment was started and the patient recovered seven weeks later. This is a rare case of autoimmune myopathy in a patient who received intravesical BCG therapy for a bladder tumor. Conclusion: The case of BCG-associated autoimmune myopathy is extremely rare. When this situation is suspected, it is beneficial to start steroid treatment without delay.

Anahtar Kelimeler

• Bacillus Calmette-Guerin
• bladder cancer
• non-muscle invasive bladder cancer
• myopathy

İntravezikal Bacillus Calmette-Guerin (BCG) İntoleransı Gelişmiş Hastada Nadir Bir Olgu: Otoimmün Miyopati

Öz

Amaç: Kasa invaze olmayan mesane kanserinin tedavisinde kullanılan intravezikal Bacillus Calmette- Guerin (BCG)’ye karşı intolerans gelişen hastada gözlenen otoimmün miyopati olgusunu sunuyoruz. Olgu: Kasa invaze olmayan mesane kanserinin tedavisinde kullanılan intravezikal BCG mesanede otoimmüniteyi artırarak etki etmektedir. Bu artan otoimmünite bazen lokal veya sistemik reaksiyonlara neden olabilmektedir. Bu olgu sunumunda, 61 yaşında bir erkek hastada idame BCG tedavisinin ilk dozu alındıktan sonra intolerans gelişti ve daha sonra tedavisine devam edilemedi. BCG intoleransı gelişiminden 1 ay sonra hasta sol kuadriseps femoris bölgesinde konvülsif ağrılı kramplar ve kas seğirmeleri şikâyeti ile kliniğimize başvurdu. Hastanın anamnezi, elektromiyografi (EMG) sonuçları, kreatin kinaz yüksekliği ve diğer laboratuvar verileri birlikte değerlendirildiğinde BCG ile tetiklenen otoimmün miyopati geliştiği düşünüldü. Bu nedenle steroid tedavisi başlandı ve hasta yedi hafta sonra sağlığına kavuştu. Bu olgu mesane tümörü için intravezikal BCG tedavisi alan hastada görülen nadir bir otoimmün miyopati olgusudur. Sonuç: BCG ile ilişkili otoimmün miyopati olgusu son derece nadirdir. Bu klinikten şüphelenildiğinde steroid tedavisinin zaman geçirilmeden başlanılmasında fayda vardır.

Anahtar Kelimeler

• Bacillus Calmette-Guerin
• mesane kanseri
• kasa invaze olmayan mesane kanseri
• miyopati

Kaynakça

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