Cited 6 times since 2018 (1 per year) source: EuropePMC International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, Volume 72, 17 3 2018, Pages 63-68 A novel view on the pathogenesis of complications after intravesical BCG for bladder cancer. Bilsen MP, van Meijgaarden KE, de Jong HK, Joosten SA, Prins C, Kroft LJM, Jonker JT, Crobach S, Pelger RC, Ottenhoff THM, Arend SM
Intravesical bacillus Calmette-Guérin (BCG) is widely used for high-risk, non-muscle-invasive bladder cancer. This report describes four cases that illustrate the spectrum of BCG-induced complications, varying from granulomatous prostatitis to sepsis. There is considerable debate regarding whether inflammation or infection is the predominant mechanism in the pathogenesis of BCG disease. In two patients with a systemic illness, the symptoms first resolved after adding prednisone, indicating a principal role for inflammation in systemic disease. In vitro testing of T-cell responses and a mycobacterial growth inhibition assay were performed for these patients with systemic disease. The patient with mild symptoms showed more effective in vitro growth reduction of BCG, while the patient with sepsis and organ involvement had high T-cell responses but ineffective killing. While these findings are preliminary, it is believed that immunological assays, as described in this report, may provide a better insight into the pathogenesis of BCG disease in individual patients, justifying further research.
