Intravesical Bacillus Calmette-Guérin (BCG) treatment's severe complications: A single institution review of incidence, presentation and treatment outcome. (May 2020)

• Record Type: Journal Article
• Authors: Waked, R.; Choucair, J.; Chehata, N.; Haddad, E.; Saliba, G.
• Is Part Of: Journal of clinical tuberculosis and other mycobacterial diseases. Volume 19(2020)
• Publication Date: 2020-05
• Subjects: Mycobacterial infection -- Intravesical Bacillus Calmette-Guérin -- Bacillus Calmette-Guerin -- Urothelial bladder cancer -- Severe complication -- Treatment protocol; BCG Bacillus Calmette-Guérin -- NMIBT Non-muscle invasive bladder tumors -- M. bovis Mycobacterium bovis -- TST Tuberculin skin testing -- PCR Polymerase chain reaction -- CT scan Computed tomography scan -- COPD Chronic obstructive pulmonary disease -- DNA Deoxyribonucleic acid; Tuberculosis -- Periodicals; Mycobacterial diseases -- Periodicals; 616.995
• DOI: 10.1016/j.jctube.2020.100149
• Languages: English
• ISSNs: 2405-5794

Abstract

Abstract: Objectives: Intravesical Bacillus Calmette-Guérin (BCG) treatment for superficial bladder cancer is interrupted in approximatively 8% of cases as a result of complications. The objective is to report the severe related complications of Bacillus Calmette-Guérin (BCG) following an intravesical instillation for bladder tumor encountered at our institution for the past 5 years. Methods: Medical records of a tertiary teaching hospital, located in Beirut, Lebanon, were retrospectively analyzed from June 2014 to June 2019 searching for severe related complications of BCG. A comprehensive review of articles on this subject was conducted. Results: The incidence of severe systemic adverse events related to BCG instillation was 1.5% (5 out of 332 patients). A total of five patients were found to have a severe BCG related complication, with fever, chills, and irritative urinary signs being the most frequent symptoms. All patients received antituberculosis therapy (Isoniazid, Rifampin and Ethambutol). Two were put on add-on corticosteroids. Three patients had a computed tomography scan image in favor of an infection. Two patients had a favorable outcome, three patients died. Conclusion: BCG severe adverse events were mostly seen in patients with a traumatic instillation. Treatment used at our institution was similar to most cases reported in the literature. A standardized diagnostic and treatment approach should be implemented to help physicians tackle these life-threatening complications.