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Diagnostics
Volume 12
Issue 4
10.3390/diagnostics12040922
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Case Report

Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer

by
Katarzyna Lewandowska
1,*,
Anna Lewandowska
1,
Inga Baranska
2,
Magdalena Klatt
3,
Ewa Augustynowicz-Kopec
3,
Witold Tomkowski
1 and
Monika Szturmowicz
1
1
1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland
2
Department of Radiology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland
3
Department of Microbiology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland
*
Author to whom correspondence should be addressed.
Diagnostics 2022, 12(4), 922; https://doi.org/10.3390/diagnostics12040922
Submission received: 10 March 2022 / Revised: 4 April 2022 / Accepted: 6 April 2022 / Published: 7 April 2022
(This article belongs to the Special Issue Challenges and Advances in Tuberculosis and Mycobacterial Lung Diseases)
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Abstract

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.
Keywords: bacillus Calmette-Guerin; bladder cancer immunotherapy; BCGosis; BCG pulmonary infection; severe respiratory insufficiency bacillus Calmette-Guerin; bladder cancer immunotherapy; BCGosis; BCG pulmonary infection; severe respiratory insufficiency

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MDPI and ACS Style

Lewandowska, K.; Lewandowska, A.; Baranska, I.; Klatt, M.; Augustynowicz-Kopec, E.; Tomkowski, W.; Szturmowicz, M. Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer. Diagnostics 2022, 12, 922. https://doi.org/10.3390/diagnostics12040922

AMA Style

Lewandowska K, Lewandowska A, Baranska I, Klatt M, Augustynowicz-Kopec E, Tomkowski W, Szturmowicz M. Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer. Diagnostics. 2022; 12(4):922. https://doi.org/10.3390/diagnostics12040922

Chicago/Turabian Style

Lewandowska, Katarzyna, Anna Lewandowska, Inga Baranska, Magdalena Klatt, Ewa Augustynowicz-Kopec, Witold Tomkowski, and Monika Szturmowicz. 2022. "Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer" Diagnostics 12, no. 4: 922. https://doi.org/10.3390/diagnostics12040922

APA Style

Lewandowska, K., Lewandowska, A., Baranska, I., Klatt, M., Augustynowicz-Kopec, E., Tomkowski, W., & Szturmowicz, M. (2022). Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer. Diagnostics, 12(4), 922. https://doi.org/10.3390/diagnostics12040922

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