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Mycobacterium bovis infection of an aortobifemoral bypass graft with Streptococcus intermedius superinfection after intravesical bacillus Calmette-Guérin immunotherapy for bladder cancer

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Abstract

Background

The Bacillus Calmette-Guerin (BCG) is a life-attenuated form of Mycobacterium bovis widely used as immunotherapy for localized bladder cancer. Adverse reactions to intravesical BCG instillations are rare.

Case

We describe a 70-year-old man with a history of an aortobifemoral bypass graft, placement of a synthetic mesh for treatment of a ventral hernia and, most recently, superficial bladder cancer treated with BCG therapy. Ten months after his final intravesical BCG instillation, he complained of fever and asthenia. After 12 months of investigation, he was diagnosed with Mycobacterium bovis infection of his aortobifemoral bypass graft and abdominal mesh, with Streptococcus intermedius superinfection. The bypass graft was excised and replaced with an in situ arterial allograft, the abdominal mesh was removed, and treatment started with amoxicillin, isoniazid, rifampicin and ethambutol. Several additional vascular interventions were needed for allograft degradation, but 12 months after the final procedure, outcome was good.

Discussion and Conclusions

Among 35 cases of mycotic aneurysm reported after BCG therapy in the last 10 years, only one involved a vascular prosthesis. Surgical repair of such aneurysms using prosthetic grafts is commonly performed, associated with anti-mycobacterial treatment. Prognosis is poor with mortality of 14% (4/35) and a 26% rate of aneurysm recurrence under treatment (9/35).

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Abbreviations

BCG:

Bacillus Calmette-Guérin

CT:

Computed tomography

PET:

Positron emission tomography

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Acknowledgments

We thank K Pickett for her editorial assistance. This case was declared to the national Pharmacovigilance system.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Université de Paris, 75006, Paris, France

    Marie Dubert, Karama Rouis & David Lebeaux

  2. Service de Microbiologie, Unité Mobile D’Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France

    Marie Dubert & David Lebeaux

  3. Service de Chirurgie Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France

    Sharon Abihssira & Pierre Julia

  4. Service de Maladies Infectieuses, Groupe Hospitalier Sud Ile de France, Melun, France

    Sylvain Diamantis

  5. Service de médecine nucléaire, Centre de Médecine Nucléaire, 77 Santepole, Melun, France

    Remi Guenin

  6. Service d’urologie, Clinique Saint Jean de L’Hermitage, Dammarie-Les-Lys, Melun, France

    Rabah Messaoudi

  7. Service de Microbiologie, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, Paris, France

    Anne-Laure Roux

  8. Centre de Pharmacovigilance, Hôpital Européen Georges Pompidou, AP-HP, Paris, France

    Agnès Lillo

  9. Service de Maladies Infectieuses, Hôpital Saint Antoine, AP-HP Sorbonne Université, Paris, France

    Laure Surgers

  10. Sorbonne université, CIMI équipe 13, INSERM U1135, 75005, Paris, France

    Laure Surgers

  11. Service de Chirurgie générale, Digestive Et Oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France

    Richard Douard

Authors
  1. Marie Dubert
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  2. Sharon Abihssira
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  3. Sylvain Diamantis
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  4. Remi Guenin
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  5. Rabah Messaoudi
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  6. Anne-Laure Roux
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  7. Karama Rouis
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  8. Agnès Lillo
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  9. Laure Surgers
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  10. Richard Douard
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  11. Pierre Julia
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  12. David Lebeaux
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Corresponding authors

Correspondence to Marie Dubert or David Lebeaux.

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The authors declare that they have no conflict of interest.

Electronic supplementary material

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15010_2020_1495_MOESM1_ESM.docx

Supplementary file1 Supplementary Table 1. Summary of the different samples and cultures from a patient with a final diagnosis of Mycobacterium bovis infection of an aortobifemoral bypass graft, with Streptococcus intermedius superinfection. Supplementary Table 2. Summary of the case reports of vascular complications after intravesical BCG instillation described over the last 10 years (DOCX 57 kb)

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Dubert, M., Abihssira, S., Diamantis, S. et al. Mycobacterium bovis infection of an aortobifemoral bypass graft with Streptococcus intermedius superinfection after intravesical bacillus Calmette-Guérin immunotherapy for bladder cancer. Infection 49, 345–348 (2021). https://doi.org/10.1007/s15010-020-01495-4

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  • DOI: https://doi.org/10.1007/s15010-020-01495-4

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