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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 05-November-2010, Vol 123 No 1325

[full text] [PDF]

BCG sepsis following inadvertent intravenous BCG administration for the treatment of bladder cancer can be effectively cured with anti-tuberculosis medications
Ziya Akbulut, Abdullah E Canda, Ali F Atmaca, Haci I Cimen, Canan Hasanoglu, Mevlana D Balbay

Abstract


Aim
To the best of our knowledge we are presenting the very first case of inadvertent intravascular administration of BCG and its successful treatment with anti-tuberculosis medications on a patient with superficial bladder cancer.

Methods
A search of the English literature (PubMed/Medline) was performed concerning inadvertent BCG administration for bladder cancer by using the key words.

Results
The patient was admitted to our hospital with high fever and chills a few hours after intravascular BCG administration. Chest CT showed bilateral infiltration of the lungs. Patient was placed on anti-tuberculosis treatment including isoniazid, rifampycin, ethambutol and methylprednisolone initially; and this treatment was adjusted according to his clinical course and liver function tests. By the end of the 4th week of hospitalisation patient was responded well with normalisation of his clinical status, liver function tests and a normal chest X-ray. Thereafter, he was discharged home on isoniazid, ethambutol for 6 months, streptomycin, cycloserine-C and ofloxacin for 2 months, methylprednisolone which was stopped eventually after dose reduction. On follow-up at 6th month after discharge from the hospital, he was fully recovered with normal chest X-ray and blood tests.

Conclusions
Development of severe sepsis is inevitable following inadvertent intravascular BCG administration. Therefore, urologists should warn and inform not only their patients and families but also healthcare workers such as nurses regarding the route of administration of the BCG treatment for bladder cancer. Our experience also proved that such a serious complication can be successfully treated if promptly acted.

     
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