• Tuberculosis and Respiratory Diseases
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• v.50 no.3
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• pp.367-372
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• 2001

Bacillus Calmette-Guerin(BCG) has been widely used for the prophylaxis of superficial bladder tumor recurrence and for the treatment of bladder carcinoma in situ. More than 95% of patients who receive BCG instillation tolerate the treatment well and side reactions have been reported in less than 5% of patients. Most side effects are minor and self-limiting. However, a rare occurrence of severe systemic reactions have been reported. Among the severe systemic reactions, hypersensitivity pneumonitis should be considered in patients with pneumonic complications after BCG instillation in cases where the culture for mycobacteria is negative in the sputwn, brochoalveolar lavage and blood specimen. In addition, a fiberoptic bronchoscopy with transbronchial lung biopsy demonstrates a fibrosis of the alveolar septums, where there is and an increased lymphocyte count with out tuberculous inflammatory changes, the and CD4 : CD8 ratio is increased and no symptomatic response to antituberculosis chemotherapy is observed. Here we report a 68 years old man with interstitial pneumonitis following intravesical BCG instillation.

• Journal of Yeungnam Medical Science
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• v.40 no.4
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• pp.430-434
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• 2023

Intravesical bacillus Calmette-Guérin (BCG) instillation is an adjuvant treatment for non-muscle-invasive urinary bladder cancer. Although most complications associated with BCG immunotherapy are mild and self-limiting, rare albeit serious complications have been reported. Only a few cases of BCG-related rhabdomyolysis have been reported. In this study, we present the case of a 72-year-old woman who developed severe weakness and hyperCKemia following intravesical BCG instillation. A muscle biopsy was performed, and a diagnosis of drug-induced myopathy was made.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.869-878
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• 1999

Intravesical instillation of the bacillus Calmentte-Gu$\acute{e}$rin(BCG), an attenuated strain of Mycobacterium bovis, is an approved method for the treatment of superficial bladder cancer. Because BCG is a living organism, the potential for infection exists. BCG is generally well tolerated, with complications in less than 5% of those treated with use of current practices. The most frequent symptoms of toxicity associated with intravesical BCG immunotherapy include bladder irritation, frequency, and dysuria. Systemic reactions are less common but more serious than local side effects, and include fever, chills, malaise, rash, hepatitis, pneumonitis, arthritis and sepsis. In rare cases, BCG treatment can result in a systemic infection that requires antituberculous therapy. The pulmonary toxicity that results from intravesical BCG treatment is generally characterized by one of two types : systemic allergic reaction with pulmonary reticulonodular opacities depicted on chest radiographs with cellular findings consisting of activated lymphocytes, and actual BCG mycobacteremia with a miliary pattern depicted on chest radiographs and granuloma formation which rarely results in positive acid-fast stain or culture results. Recently we experienced two types of pulmonary complications following intravesical BCG immunotherapy in patients with superficial bladder cancer. We report two cases with a review of literatures.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.9
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• pp.4357-4361
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• 2012

Objective: The guidelines on indications for prophylactic use of Bacille Calmette-Gu$\acute{e}$rin (BCG) against non-muscle-invasive bladder cancer (NMIBC) have changed over the years. In order to assess the impact on outcome, the present retrospective comparison of BCG efficacy by time period with Japanese patients was conducted. Patients and Methods: A total of 146 cases of NMIBC treated with BCG since February 1985 were retrospectively evaluated. All patients received 80 mg of BCG (Tokyo 172 strain) six to eight times a week for prophylactic use. Comparison was made among three historical groups (Group A: 1980's, 39 cases; Group B: 1990's, 61 cases; Group C: 2000's, 46 cases). Results: In total, recurrence was seen in 55 of the 146 cases (37.7%), and progression in 14 (9.6%), 1 patient dying of cancer. These overall results were similar to those outlined in previous reports. However, the outcomes of this time-period-based analysis indicated a tendency for a shorter time to recurrence in patients after 2000, although a log-rank test showed no significance (P=0.229). Seven of the cases featuring progression (i.e., half of all such cases) were among the 46 Group C patients (15.2%). Excluding these progressive cases, there was no significant difference among the remaining 132 patients in the three groups. Conclusion: This study results revealed a tendency for a lower non-recurrence rate after 2000 in our series. This could stem from a number of factors, including changes in BCG indication criteria and the evolution of histopathological diagnostic criteria.

• Journal of Yeungnam Medical Science
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• v.4 no.2
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• pp.113-120
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• 1987

The effect of intravesical formalin instillation as a therapeutic modality for intractable bladder hemorrhage is well known. And despite clear evidence of therapeutic efficacy of intravesical cytotoxic drugs and/or BCG immunotherapy, there have been substantial recurrences during followup after transurethral resection for superficial bladder tumor. If formalin injected at the bed of superficial bladder tumor is able to coagulate and necrotize the tumor, it will be greatly helpful to the patients With recurrent bladder tumor developed during followup. Since this technique is applicable on outpatient basis, an economical as well as a psychological burden of the patients can be reduced considerably. The purpose of this study is to evaluate the effect of submucosal formalin injection on rat bladder wall, 36 healthy adult male Sprague-Dawley rats (weighing 350gm in average) were divided into 3 groups: In Group I (control group), 0.01ml of normal saline was injected submucosally at the left posterolateral wall of the bladder opened under intraperitoneal Nembutal anesthesia ; In Group II and III, 0.01 ml of 10% and 4% formalin, respectively, were administered at the same site as in the Group I, two rats in each group were sacrificed at day 1, 2, and 3, and week 1, 2 and 4 after injection, respectively. Gross and microscopic examination of the cystectomized specimen were done in each group. In the Group II, bladder stones were formed at week I, and in both the Group I and III, stones were seen at week 2 post injection. There was no significant difference III histologic findings of the bladder between the group II and III. Mucosal ulcer and/or prominent mucosal disruption was observed at 24 hours after injection in both Group II and III. Epithelial regeneration began at day 2, and was marked at day 3, and epithelial lining was almost normalized one week after injection. Subepithelial edema, telangiectasia and inflammatory reaction were prominent at 24 hours post formalin injection. Subepithelial edema persisted in moderate degree for 1 week. Telangiectasia and inflammatory reaction were noted for 4 weeks. Mild degree of these findings also appeared In the control group. Fibroblastic proliferation appeared at day 2 and persisted in moderate degree for 4 weeks. There has been no mortality or bladder perforation. These results suggest that clinical application of this technique is feasible for the selected cases of recurrent, solitary superficial bladder tumor. However, optimal dosage of formalin in relation to the size of the lesion remains to be investigated.