Rare complications post intravesical application of Bacillus-Calmette Guérin (BGG) vaccine

Overview

Introduction: BCG vaccine treatment is the gold standard for high-risk non-muscle invasive urothelial bladder cancer. The most common complications after BCG treatment are hematuria and symptoms of lower urinary tract infection. Rarely, systemic symptoms occur such as fever or BCG sepsis. As of 2020, the vaccine was administered at our department to 66 patients, of which 6 patients had complications that required interruption of instillations. In this article, we report two rare complications of BCG vaccine therapy – BCG sepsis and the development of a tuberculous prostate abscess.

Description of cases: Patient 1 – A 70-year-old patient with a pT1HG bladder tumor developed fever after the 5th dose of the initial course, elevated liver function tests and bilateral lung lesions were present on CT scan. Antituberculosis treatment was started, after which the patient‘s condition improved very slowly.

Patient 2 – A 70-year-old patient with a pT1HG bladder tumor had a post-BCG, PSA level was 8.9 so we performed a MRI of a prostatae, which showed a suspicious PIRADS 4 and 5 lesion. Caseous necrosis was confirmed histologically from the biopsy, the PCR test for M. tuberculosis was positive. The patient is now being treated with antituberculotic drugs.

Conclusion: The most common complications of BCG vaccine treatment are lower urinary tract symptoms (LUTS) and lower urinary tract infections; rarely, systemic complications requiring treatment discontinuation may occur.

Keywords:

tuberculosis – urinary bladder – complications – urothelial cancer – BCG