Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy: Case report

Cindy Q. Gao, Rozina Mithani, Jack Leya, Lesley Dawravoo, Arvin Bhatia, John Antoine, Felipe De Alba, Peter A. Russo, Claus J. Fimmel

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Intravesical instillation of Bacillus Calmette-Guérin (BCG) is the treatment of choice for superficial bladder carcinoma. Complications of BCG therapy include local infections and disseminated BCG infection with multiple endorgan complications.Case Presentation: We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis. After successful anti-mycobacterial therapy and resolution of the hepatic and ocular abnormalities, the patient developed an acute upper gastrointestinal hemorrhage from an aortoduodenal fistula that required emergency surgery. The resection specimen revealed multifocal, non-caseating granulomas, indicating mycobacterial involvement.Conclusions: This case highlights the varied end organ complications of disseminated BCG infection, and the need for vigilance even in immuno-competent patients with a history of intravesical BCG treatment.

Original languageEnglish (US)
Article number260
JournalBMC Infectious Diseases
Volume11
DOIs
StatePublished - Sep 30 2011

Fingerprint

Choroiditis
Bacillus
Hepatitis
Fistula
Infection
Therapeutics
Eye Abnormalities
Intravesical Administration
Gastrointestinal Hemorrhage
Granuloma
Urinary Bladder
Emergencies
Carcinoma
Liver

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy : Case report. / Gao, Cindy Q.; Mithani, Rozina; Leya, Jack; Dawravoo, Lesley; Bhatia, Arvin; Antoine, John; De Alba, Felipe; Russo, Peter A.; Fimmel, Claus J.

In: BMC Infectious Diseases, Vol. 11, 260, 30.09.2011.

Research output: Contribution to journalArticle

Gao, Cindy Q. ; Mithani, Rozina ; Leya, Jack ; Dawravoo, Lesley ; Bhatia, Arvin ; Antoine, John ; De Alba, Felipe ; Russo, Peter A. ; Fimmel, Claus J. / Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy : Case report. In: BMC Infectious Diseases. 2011 ; Vol. 11.
@article{6799b303ed0740aca7a8400cf3afd6ee,
title = "Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Gu{\'e}rin therapy: Case report",
abstract = "Background: Intravesical instillation of Bacillus Calmette-Gu{\'e}rin (BCG) is the treatment of choice for superficial bladder carcinoma. Complications of BCG therapy include local infections and disseminated BCG infection with multiple endorgan complications.Case Presentation: We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis. After successful anti-mycobacterial therapy and resolution of the hepatic and ocular abnormalities, the patient developed an acute upper gastrointestinal hemorrhage from an aortoduodenal fistula that required emergency surgery. The resection specimen revealed multifocal, non-caseating granulomas, indicating mycobacterial involvement.Conclusions: This case highlights the varied end organ complications of disseminated BCG infection, and the need for vigilance even in immuno-competent patients with a history of intravesical BCG treatment.",
author = "Gao, {Cindy Q.} and Rozina Mithani and Jack Leya and Lesley Dawravoo and Arvin Bhatia and John Antoine and {De Alba}, Felipe and Russo, {Peter A.} and Fimmel, {Claus J.}",
year = "2011",
month = "9",
day = "30",
doi = "10.1186/1471-2334-11-260",
language = "English (US)",
volume = "11",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy

T2 - Case report

AU - Gao, Cindy Q.

AU - Mithani, Rozina

AU - Leya, Jack

AU - Dawravoo, Lesley

AU - Bhatia, Arvin

AU - Antoine, John

AU - De Alba, Felipe

AU - Russo, Peter A.

AU - Fimmel, Claus J.

PY - 2011/9/30

Y1 - 2011/9/30

N2 - Background: Intravesical instillation of Bacillus Calmette-Guérin (BCG) is the treatment of choice for superficial bladder carcinoma. Complications of BCG therapy include local infections and disseminated BCG infection with multiple endorgan complications.Case Presentation: We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis. After successful anti-mycobacterial therapy and resolution of the hepatic and ocular abnormalities, the patient developed an acute upper gastrointestinal hemorrhage from an aortoduodenal fistula that required emergency surgery. The resection specimen revealed multifocal, non-caseating granulomas, indicating mycobacterial involvement.Conclusions: This case highlights the varied end organ complications of disseminated BCG infection, and the need for vigilance even in immuno-competent patients with a history of intravesical BCG treatment.

AB - Background: Intravesical instillation of Bacillus Calmette-Guérin (BCG) is the treatment of choice for superficial bladder carcinoma. Complications of BCG therapy include local infections and disseminated BCG infection with multiple endorgan complications.Case Presentation: We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis. After successful anti-mycobacterial therapy and resolution of the hepatic and ocular abnormalities, the patient developed an acute upper gastrointestinal hemorrhage from an aortoduodenal fistula that required emergency surgery. The resection specimen revealed multifocal, non-caseating granulomas, indicating mycobacterial involvement.Conclusions: This case highlights the varied end organ complications of disseminated BCG infection, and the need for vigilance even in immuno-competent patients with a history of intravesical BCG treatment.

UR - http://www.scopus.com/inward/record.url?scp=80053357069&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053357069&partnerID=8YFLogxK

U2 - 10.1186/1471-2334-11-260

DO - 10.1186/1471-2334-11-260

M3 - Article

C2 - 21961922

AN - SCOPUS:80053357069

VL - 11

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

M1 - 260

ER -