We observed a 76-year-old man who presented “acute kidney-lung failure” 9 months after intravesical Bacillus Calmette-Guérin (BCG) adjuvant treatment for a T1 bladder cancer. He had inflammatory infiltration on...We observed a 76-year-old man who presented “acute kidney-lung failure” 9 months after intravesical Bacillus Calmette-Guérin (BCG) adjuvant treatment for a T1 bladder cancer. He had inflammatory infiltration on chest radiography and required dialysis for acute renal failure. A percutaneous renal biopsy was performed and revealed tubulointerstitial nephritis with a moderate eosinophilic infiltrate without granulomatous lesion. After a few days, an open lung biopsy was also done due to respiratory deterioration. The anatomopathologic specimen demonstrated moderate fibrosis with lympho-neutrophilic infiltration and few aspecific granulomatous lesions without caseous necrosis. Sarcoidosis was suspected and high dose oral methylprednisolone was started. Three weeks later, Mycobacterium bovis was identified by Polymerase Chain Reaction on open lung biopsy. He responded well to steroids and tuberculostatic tri-therapy. After one month of immunosuppressive treatment, renal function was resolved and hemodialysis could be discontinued. Despite the frequent use of adjuvant BCG immunotherapy, systemic complications such as hepatitis, pneumonitis, spondylodiscitis or multiorgan failure are rare (<1%). Hematogenous dissemination which occurs a few weeks after traumatic instillations is usually suspected but not demonstrated because of absence of mycobacterium in histological specimen. Our case differs from those previously reported by the simultaneous presence of acid-fast bacilli highlighted on lung samples. We discuss the pathophysiology of BCG complications, the use of prophylactic or therapeutic treatment and recommend guidelines to prevent such complications.展开更多
目的评价卡介菌多糖核酸（Polysacehafide nucleic aeidefraetion of BCG,BCG-PSN）作为免疫调节剂与异蝈肼、链霉素、利福喷丁和乙胺丁醇联用治疗初治痰涂阳性肝功损害肺结核患者的有效性和安全性。方法6l例因利福平治疗1—2周后出现...目的评价卡介菌多糖核酸（Polysacehafide nucleic aeidefraetion of BCG,BCG-PSN）作为免疫调节剂与异蝈肼、链霉素、利福喷丁和乙胺丁醇联用治疗初治痰涂阳性肝功损害肺结核患者的有效性和安全性。方法6l例因利福平治疗1—2周后出现肝功损害痰涂阳性肺结核患者随机分为试验组（3I例）和对照组（30倒）。试验组给予BCG—PSN与异烟肼、链霉素、利福喷丁和乙胺丁醇联用。对照组仅给予相同联合化疗，观察并分析其疗效及肝功能变化。结果试验组6个月痰菌阴转率、病变吸收好转率分别为93．2％和96．8％，对照组分别为83．3％和93．3％。经统计学处理。试验组6个月痰菌阴转率明显高于对照组（P〈0．05），两组病变吸收好转率无明显差异（P〉0．05）；而肝功能改善情况两组结果相近；试验组第6个月血清IgG、CD8（％）测值比对照组明显降低（P〈0.05），相反CD4（％）、CD4／CD8和C3测值比对照组明显增高（P〈0．05）。结论BCG-PSN注射液可通过改善患者免疫功能。明显提高短程化疗肝功能损害肺结核患者的初治疗效，且使用方便、安全。展开更多
文摘We observed a 76-year-old man who presented “acute kidney-lung failure” 9 months after intravesical Bacillus Calmette-Guérin (BCG) adjuvant treatment for a T1 bladder cancer. He had inflammatory infiltration on chest radiography and required dialysis for acute renal failure. A percutaneous renal biopsy was performed and revealed tubulointerstitial nephritis with a moderate eosinophilic infiltrate without granulomatous lesion. After a few days, an open lung biopsy was also done due to respiratory deterioration. The anatomopathologic specimen demonstrated moderate fibrosis with lympho-neutrophilic infiltration and few aspecific granulomatous lesions without caseous necrosis. Sarcoidosis was suspected and high dose oral methylprednisolone was started. Three weeks later, Mycobacterium bovis was identified by Polymerase Chain Reaction on open lung biopsy. He responded well to steroids and tuberculostatic tri-therapy. After one month of immunosuppressive treatment, renal function was resolved and hemodialysis could be discontinued. Despite the frequent use of adjuvant BCG immunotherapy, systemic complications such as hepatitis, pneumonitis, spondylodiscitis or multiorgan failure are rare (<1%). Hematogenous dissemination which occurs a few weeks after traumatic instillations is usually suspected but not demonstrated because of absence of mycobacterium in histological specimen. Our case differs from those previously reported by the simultaneous presence of acid-fast bacilli highlighted on lung samples. We discuss the pathophysiology of BCG complications, the use of prophylactic or therapeutic treatment and recommend guidelines to prevent such complications.
文摘目的评价卡介菌多糖核酸（Polysacehafide nucleic aeidefraetion of BCG,BCG-PSN）作为免疫调节剂与异蝈肼、链霉素、利福喷丁和乙胺丁醇联用治疗初治痰涂阳性肝功损害肺结核患者的有效性和安全性。方法6l例因利福平治疗1—2周后出现肝功损害痰涂阳性肺结核患者随机分为试验组（3I例）和对照组（30倒）。试验组给予BCG—PSN与异烟肼、链霉素、利福喷丁和乙胺丁醇联用。对照组仅给予相同联合化疗，观察并分析其疗效及肝功能变化。结果试验组6个月痰菌阴转率、病变吸收好转率分别为93．2％和96．8％，对照组分别为83．3％和93．3％。经统计学处理。试验组6个月痰菌阴转率明显高于对照组（P〈0．05），两组病变吸收好转率无明显差异（P〉0．05）；而肝功能改善情况两组结果相近；试验组第6个月血清IgG、CD8（％）测值比对照组明显降低（P〈0.05），相反CD4（％）、CD4／CD8和C3测值比对照组明显增高（P〈0．05）。结论BCG-PSN注射液可通过改善患者免疫功能。明显提高短程化疗肝功能损害肺结核患者的初治疗效，且使用方便、安全。
