SHM Converge Scientific Abstract ePoster Gallery-Ruptured Mycotic Aneurysm and Pleurisy Due to Mycobacterium Bovis Infection After Intravesical Bacille Calmette-Guérin Therapy

Ruptured Mycotic Aneurysm and Pleurisy Due to Mycobacterium Bovis Infection After Intravesical Bacille Calmette-Guérin Therapy

Back to course

Pdf Summary

This case report describes a rare systemic complication of intravesical Bacillus Calmette-Guérin (BCG) therapy for bladder cancer. A 91-year-old man with a history of bladder cancer treated with transurethral resection and seven BCG instillations was admitted with a ruptured thoracic aortic aneurysm. Because open aneurysm repair was considered too risky due to his age, he underwent emergency thoracic endovascular aortic repair.<br /><br />After surgery, pleural fluid studies were initially negative for acid-fast bacilli, but PCR identified Mycobacterium tuberculosis complex, later confirmed by multiplex PCR as Mycobacterium bovis. Thoracoscopy performed under local anesthesia revealed white pleural thickening, and cultures from the pleura also grew M. bovis. The final diagnosis was a ruptured mycotic aneurysm with secondary pleurisy caused by M. bovis infection related to prior intravesical BCG therapy.<br /><br />He was treated with isoniazid, rifampin, and ethambutol, which led to symptom improvement and resolution of symptoms. The report emphasizes that while intravesical BCG is generally safe and widely used for non-muscle-invasive bladder cancer, rare systemic complications can occur, including mycotic aneurysm and pleurisy.<br /><br />The authors stress the importance of considering BCG-related infection in patients who develop fever or other unexplained systemic symptoms after BCG therapy. They also note that diagnosis may be delayed because symptoms are nonspecific, and that management often requires both surgical/endovascular intervention and antimycobacterial treatment.

Asset Subtitle

Yoshitaka Tomoda

Meta Tag

Author List Kenji Motohashi, Kentaro Ishikura, Kohei Ukai, Manabu Yamasaki, Mikiko Ozaki, Yasuhiro Komatsu, Yoshitaka Tomoda

Category Clinical Vignettes

Concept Intravesical Bacillus Calmette-Guérin therapy

Concept Mycobacterium bovis infection

Concept Mycotic aneurysm

Concept Pleuritis

Concept Endovascular repair

Distinguished Non-Finalist

Presenter Organization Itabashi Chuo Medical Center

Presenting Author Yoshitaka Tomoda

Track Adult

Keywords

intravesical BCG therapy

Mycobacterium bovis

mycotic aneurysm

thoracic aortic aneurysm

bladder cancer

pleurisy

acid-fast bacilli

thoracic endovascular aortic repair

antimycobacterial treatment

BCG infection

Intravesical Bacillus Calmette-Guérin therapy

Mycobacterium bovis infection

Mycotic aneurysm

Pleuritis

Endovascular repair