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1/45. Diffuse alveolar damage in BCGosis: a rare complication of intravesical bacillus Calmette-Guerin therapy for transitional cell carcinoma.

    Intravesical administration of bacillus Calmette-Guerin is a relatively simple procedure used in the treatment of superficial transitional cell carcinoma of the urinary bladder. It is usually well tolerated with few major side effects. In rare instances, systemic complications can result in death. The usual autopsy finding is that of caseating and non-caseating granulomata in the affected organ. We report the second case of BCGosis in which granulomata together with acute and organising phase diffuse alveolar damage were found in the lungs.
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2/45. bacillus Calmette-Guerin associated arthropathy mimicking undifferentiated spondyloarthropathy.

    The development of an inflammatory arthritis mimicking an undifferentiated spondyloarthropathy (SpA) was seen in a patient being treated for a superficial bladder cancer with intravesical bacillus Calmette-Guerin (BCG). Physical findings included classic dactylitis of both feet. This is the fourth report identifying a patient with BCG induced articular findings suggestive of a SpA with dactylitis. Studies of BCG stimulated cytokine secretion from peripheral blood mononuclear cells showed the patient to have enhanced interleukin 6 (IL-6) levels and reduced interferon-gamma (IFN-gamma) levels. Spontaneous IL-6 secretion was markedly elevated for the patient, compared to the control subject, but IFN-gamma secretion was quite similar. No differences were apparent with IL-4.
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keywords = bacillus
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3/45. Granulomatous hepatitis following intravesical bacillus Calmette-Guerin therapy.

    Although intravesical bacillus Calmette-Guerin (BCG) administration is an effective method in the treatment of superficial urinary bladder carcinoma, some complications may arise such as a granulomatous reaction either in the urinary tract or, in rare cases, outside the urinary tract. We report in this paper a case of granulomatous hepatitis following intravesical BCG administration.
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4/45. Epididymo-orchitis following intravesical bacillus Calmette-Guerin therapy.

    OBJECTIVE: To describe a case of epididymo-orchitis that developed four years after treatment with intravesical bacillus Calmette-Guerin (BCG) and to review the incidence of this adverse effect. DATA SOURCES: Information about the patient was obtained from the medical chart. A medline search of English-language literature (from January 1976 to April 1999) was conducted. STUDY SELECTION: All case reports of BCG-related epididymo-orchitis were evaluated. review articles describing complications of BCG therapy for bladder cancer and the prevention and treatment of these complications were reviewed. DATA EXTRACTION: Studies were evaluated for reports of BCG-related epididymo-orchitis and its treatment. DATA SYNTHESIS: Our case report is compared with others reported in the literature. The incidence of BCG-associated epididymoorchitis is rare. CONCLUSIONS: Epididymo-orchitis should be considered as a late complication of BCG therapy for bladder cancer. Proper patient selection may help decrease the risk of complications from BCG therapy.
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5/45. hepatitis in disseminated bacillus Calmette-Guerin infection.

    Local immunotherapy with an attenuated live strain of mycobacterium bovis, bacillus Calmette-Guerin (BCG), is an effective and frequently used treatment for in situ transitional cell carcinoma (TCC) of the bladder. Success rates are high, and serious side effects are infrequent but can affect every organ system. A 79-year-old patient with recently diagnosed TCC who was treated with intravesical BCG for a recurrence after initial surgical treatment is reported. After unsuccessful attempts at bladder catheterization with the creation of a false passage for his third treatment, BCG was instilled via a suprapubic catheter the same day and again a week later. Two weeks after the third BCG instillation, the patient presented with profound lethargy and weakness to the point of not being able to get up out of a chair. He was febrile, anorexic, icteric and had hepatosplenomegaly. Disseminated BCG infection was suspected on the basis of history, clinical examination and a liver biopsy that showed noncaseating granulomatous hepatitis. Empirical treatment was started with antituberculous combination therapy. A short course of an oral corticosteroid was given. Clinical improvement was marked and sustained so that the patient could be discharged home for the full six-month course of his treatment. Disseminated BCG infection with granulomatous hepatitis can be severe and life-threatening in cases where a large intravascular inoculum of BCG may have been given inadvertently.
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ranking = 1.0100186403184
keywords = bacillus, bovis
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6/45. Miliary mycobacterium bovis induced by intravesical bacille Calmette-Guerin immunotherapy.

    Intravesical instillation of bacille Calmette-Guerin (BCG), an attenuated strain of mycobacterium bovis, is the treatment of choice for many patients with bladder cancer. In a small percentage, this therapy is associated with systemic side effects including pneumonitis. It is uncertain whether these systemic manifestations are due to dissemination of infection or due to hypersensitivity, an etiologic distinction that has important therapeutic implications. We report the first case in which miliary M. bovis was proven to be the responsible mechanism, by culture of M. bovis biovar BCG from a transbronchial lung biopsy and complete resolution on anti-tuberculous chemotherapy.
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ranking = 0.07013048222847
keywords = bovis
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7/45. vitiligo--an autoimmune side-effect of intravesical bacillus Calmette-Guerin instillation?

    We report a case of vitiligo in a 63-year-old man who had undergone intravesical bacillus Calmette-Guerin treatment following removal of a superficial transitional cell carcinoma in the bladder.
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8/45. bacillus Calmette-Guerin-induced granulomatous hepatitis in a patient with a superficial bladder carcinoma.

    A 71-year-old male patient with a superficial transitional cell carcinoma of the urinary bladder developed high fever and jaundice, accompanied by progressively increasing serum aminotransferase activities, 2 weeks after the fourth local instillation with an attenuated live strain of mycobacterium bovis [bacillus Calmette-Guerin (BCG)]. A liver biopsy showed non-caseating granulomatous hepatitis. Cultures for mycobacteria were negative. Mycobacterial dna was not detected in liver tissue using the polymerase chain reaction. Empirical treatment with rifampicin and isoniazid was started, resulting in partial recovery. After 6 months of therapy, however, serum aminotransferase activities were still twice the upper limit of normal. A second liver biopsy still demonstrated several granulomas. Only after addition of prednisolone, liver tests completely normalized. Also histologically the lesions improved dramatically. This suggests that the BCG hepatitis was at least partially caused by a hypersensitivity reaction. Our patient is the first reported case of BCG hepatitis with histological follow-up under therapy.
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ranking = 0.21001864031835
keywords = bacillus, bovis
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9/45. The dangerous ureter.

    Seven patients with recurring transitional cell carcinoma of the urinary bladder were treated with repeated transurethral resections of these tumors and were given adjuvant intravesical chemotherapy or bacillus-Calmette Guerin (BCG) vaccine. Carcinoma either in the ureters or renal pelves subsequently developed in these patients. Unfortunately, 2 patients had inoperable tumors when the diagnosis was confirmed. When treating patients with recurring carcinoma of the urinary bladder, the possibility of upper urinary tract tumors developing must always be considered. Hence, the necessity of frequent urinary and ureteral cytology examinations proceeding to excretory urography, retrograde pyelograms, computerized tomography (CT) scans of the upper tracts, or ureteroscopy as may be necessary to locate small tumors or to diagnose carcinoma in situ.
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keywords = bacillus
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10/45. Reactive arthritis following BCG immunotherapy for bladder carcinoma.

    Intravesical instillation of bacillus Calmette-Guerin (BCG) is used in the treatment of patients with intermediate and high-risk superficial bladder carcinoma with efficacy and safety. The vast majority of patients do not present any side effects and only 5% of patients have mild and short-lived clinical manifestations such as malaise, low-grade fever, cystitis, and hematuria. arthralgia and/or arthritis is one of the rare severe complications following intravesical BCG immunotherapy. We report here the case of a patient with reactive arthritis successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs) after the discontinuation of BCG immunotherapy.
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ranking = 0.2
keywords = bacillus
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