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Bone marrow infection with bacillus Calmette-Guérin (BCG) after intravesical immunotherapy

Knochenmarksinfiltration durch Bacillus Calmette-Guérin (BCG) nach intravesikaler Immuntherapie

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Zusammenfassung

Die lokale Bacillus Calmette-Guérin (BCG)-Immuntherapie mit intravesikaler Instillation ist eine wirksame und etablierte Behandlung von Blasentumoren. Da ein Lebendstamm (wenn auch attenuiert) von Mycobacterium (M.) bovis verwendet wird, besteht grundsätzlich die Gefahr einer iatrogenen Infektion mit BCG. Diese ist selten, jedoch wurden sowohl lokale als auch generalisierte Infektionen mit BCG im Anschluss an eine Immuntherapie beschrieben. Wir berichten über einen Patienten, der zwei Jahre nach intravesikaler Applikation von BCG zur Therapie eines Blasenkarzinoms an einer Infektion des Knochenmarks erkrankte. Der klinische Verlauf war von Fieber, Gewichtsverlust und einer Panzytopenie im Labor gekennzeichnet. Eine Knochenmarksuntersuchung mit Biopsie ergab den Befund einer granulomatösen Entzündung, der M. bovis-BCG-Stamm konnte aus dem Urin kultiviert werden. Die nachfolgende tuberkulostatische Therapie mit Isoniazid, Rifampizin und Ethambutol (M. bovis ist immer resistant gegenüber Pyrazinamid) führte zur vollständigen klinischen Erholung des Patienten.

Summary

Instillation of bacillus Calmette-Guérin (BCG) into the urine bladder is an effective treatment of superficial bladder cancer. BCG-mediated anti-tumor activity appears to be a local phenomenon in which cell-mediated immunity, involving cytotoxic T cells, lymphokine-activated killer cells and natural killer cells, is important for the elimination of malignant cells. Serious side-effects of BCG therapy are rare; nevertheless, BCG is a live, attenuated strain of Mycobacterium (M.) bovis and may exhibit invasive properties. Both local and distant or generalized infections have been reported after treatment with BCG. We describe the case of a 68-year-old man who developed bone marrow infection with BCG two years after intravesical instillation of BCG for treatment of superficial bladder cancer. He presented with intermittent fever, weight loss and pronounced pancytopenia. A bone marrow biopsy specimen showed granulomatous inflammation and BCG was cultured from the urine. Anti-mycobacterial treatment with isoniazid, rifampicin and ethambutol (pyrazinamide is inactive against M. bovis) led to full clinical recovery of the patient.

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Authors and Affiliations

  1. Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria

    Johannes Nemeth, Brigitte Stoiser, Heide-Maria Winkler, Wolfgang Graninger & Stefan Winkler

  2. Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria

    Leonard Müllauer

Authors
  1. Johannes Nemeth
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  2. Brigitte Stoiser
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  3. Heide-Maria Winkler
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  4. Leonard Müllauer
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  5. Wolfgang Graninger
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  6. Stefan Winkler
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Corresponding author

Correspondence to Stefan Winkler.

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Nemeth, J., Stoiser, B., Winkler, HM. et al. Bone marrow infection with bacillus Calmette-Guérin (BCG) after intravesical immunotherapy. Wien Klin Wochenschr 120, 121–123 (2008). https://doi.org/10.1007/s00508-007-0902-4

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  • DOI: https://doi.org/10.1007/s00508-007-0902-4

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