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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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Autores principales: Lewandowska, Katarzyna, Lewandowska, Anna, Baranska, Inga, Klatt, Magdalena, Augustynowicz-Kopec, Ewa, Tomkowski, Witold, Szturmowicz, Monika
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9026867/
https://www.ncbi.nlm.nih.gov/pubmed/35453970
http://dx.doi.org/10.3390/diagnostics12040922
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author Lewandowska, Katarzyna
Lewandowska, Anna
Baranska, Inga
Klatt, Magdalena
Augustynowicz-Kopec, Ewa
Tomkowski, Witold
Szturmowicz, Monika
author_facet Lewandowska, Katarzyna
Lewandowska, Anna
Baranska, Inga
Klatt, Magdalena
Augustynowicz-Kopec, Ewa
Tomkowski, Witold
Szturmowicz, Monika
author_sort Lewandowska, Katarzyna
collection PubMed
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 M. tuberculosis complex was obtained from the patient’s specimens; the cultured strain was identified as Mycobacterium bovis 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.
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spelling pubmed-90268672022-04-23 Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer Lewandowska, Katarzyna Lewandowska, Anna Baranska, Inga Klatt, Magdalena Augustynowicz-Kopec, Ewa Tomkowski, Witold Szturmowicz, Monika Diagnostics (Basel) Case Report 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 M. tuberculosis complex was obtained from the patient’s specimens; the cultured strain was identified as Mycobacterium bovis 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. MDPI 2022-04-07 /pmc/articles/PMC9026867/ /pubmed/35453970 http://dx.doi.org/10.3390/diagnostics12040922 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Lewandowska, Katarzyna
Lewandowska, Anna
Baranska, Inga
Klatt, Magdalena
Augustynowicz-Kopec, Ewa
Tomkowski, Witold
Szturmowicz, Monika
Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer
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 Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9026867/
https://www.ncbi.nlm.nih.gov/pubmed/35453970
http://dx.doi.org/10.3390/diagnostics12040922
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