Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer
Intra-vesical instillations with bacillus Calmette-Guerin (BCG) are the established adjuvant therapy for superficial bladder cancer. Although generally safe and well tolerated, they may cause a range of different, local, and systemic complications. We present a patient treated with BCG instillations...
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| Format: | Article |
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MDPI AG
2022-04-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/4/922 |
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| author | Katarzyna Lewandowska Anna Lewandowska Inga Baranska Magdalena Klatt Ewa Augustynowicz-Kopec Witold Tomkowski Monika Szturmowicz |
| author_facet | Katarzyna Lewandowska Anna Lewandowska Inga Baranska Magdalena Klatt Ewa Augustynowicz-Kopec Witold Tomkowski Monika Szturmowicz |
| author_sort | Katarzyna Lewandowska |
| collection | DOAJ |
| description | Intra-vesical instillations with bacillus Calmette-Guerin (BCG) are the established adjuvant therapy for superficial bladder cancer. Although generally safe and well tolerated, they may cause a range of different, local, and systemic complications. We present a patient treated with BCG instillations for three years, who was admitted to our hospital due to fever, hemoptysis, pleuritic chest pain and progressive dyspnea. Chest computed tomography (CT) showed massive bilateral ground glass opacities, partly consolidated, localized in the middle and lower parts of the lungs, bronchial walls thickening, and bilateral hilar lymphadenopathy. PCR tests for SARS-CoV-2 as well as sputum, blood, and urine for general bacteriology—were negative. Initial empiric antibiotic therapy was ineffective and respiratory failure progressed. After a few weeks, a culture of <i>M. tuberculosis</i> complex was obtained from the patient’s specimens; the cultured strain was identified as <i>Mycobacterium bovis</i> BCG. Anti-tuberculous treatment with rifampin (RMP), isoniazid (INH) and ethambutol (EMB) was implemented together with systemic corticosteroids, resulting in the quick improvement of the patient’s clinical condition. Due to hepatotoxicity and finally reported resistance of the BCG strain to INH, levofloxacin was used instead of INH with good tolerance. Follow-up CT scans showed partial resolution of the pulmonary infiltrates. BCG infection in the lungs must be taken into consideration in every patient treated with intra-vesical BCG instillations and symptoms of protracted infection. |
| first_indexed | 2024-03-09T10:57:26Z |
| format | Article |
| id | doaj.art-988fc50e81924625877924613f03b122 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T10:57:26Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-988fc50e81924625877924613f03b1222023-12-01T01:33:28ZengMDPI AGDiagnostics2075-44182022-04-0112492210.3390/diagnostics12040922Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder CancerKatarzyna Lewandowska0Anna Lewandowska1Inga Baranska2Magdalena Klatt3Ewa Augustynowicz-Kopec4Witold Tomkowski5Monika Szturmowicz61st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, PolandDepartment of Radiology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, PolandDepartment of Microbiology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, PolandDepartment of Microbiology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, PolandIntra-vesical instillations with bacillus Calmette-Guerin (BCG) are the established adjuvant therapy for superficial bladder cancer. Although generally safe and well tolerated, they may cause a range of different, local, and systemic complications. We present a patient treated with BCG instillations for three years, who was admitted to our hospital due to fever, hemoptysis, pleuritic chest pain and progressive dyspnea. Chest computed tomography (CT) showed massive bilateral ground glass opacities, partly consolidated, localized in the middle and lower parts of the lungs, bronchial walls thickening, and bilateral hilar lymphadenopathy. PCR tests for SARS-CoV-2 as well as sputum, blood, and urine for general bacteriology—were negative. Initial empiric antibiotic therapy was ineffective and respiratory failure progressed. After a few weeks, a culture of <i>M. tuberculosis</i> complex was obtained from the patient’s specimens; the cultured strain was identified as <i>Mycobacterium bovis</i> BCG. Anti-tuberculous treatment with rifampin (RMP), isoniazid (INH) and ethambutol (EMB) was implemented together with systemic corticosteroids, resulting in the quick improvement of the patient’s clinical condition. Due to hepatotoxicity and finally reported resistance of the BCG strain to INH, levofloxacin was used instead of INH with good tolerance. Follow-up CT scans showed partial resolution of the pulmonary infiltrates. BCG infection in the lungs must be taken into consideration in every patient treated with intra-vesical BCG instillations and symptoms of protracted infection.https://www.mdpi.com/2075-4418/12/4/922bacillus Calmette-Guerinbladder cancer immunotherapyBCGosisBCG pulmonary infectionsevere respiratory insufficiency |
| spellingShingle | Katarzyna Lewandowska Anna Lewandowska Inga Baranska Magdalena Klatt Ewa Augustynowicz-Kopec Witold Tomkowski Monika Szturmowicz Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer Diagnostics bacillus Calmette-Guerin bladder cancer immunotherapy BCGosis BCG pulmonary infection severe respiratory insufficiency |
| title | Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer |
| title_full | Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer |
| title_fullStr | Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer |
| title_full_unstemmed | Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer |
| title_short | Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer |
| title_sort | severe respiratory failure due to pulmonary bcgosis in a patient treated for superficial bladder cancer |
| topic | bacillus Calmette-Guerin bladder cancer immunotherapy BCGosis BCG pulmonary infection severe respiratory insufficiency |
| url | https://www.mdpi.com/2075-4418/12/4/922 |
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