A Case Report of Mycotic Aneurysm Following Intravesical Bacillus Calmette-Gue´rin Instillation Therapy for Bladder Cancer

(Department of Cardiovascular Surgery Fukuyama City Hospital, Fukuyama, Japan)

Yukio Kioka Atsushi Tanabe Mitsuhito Kuriyama
Bacillus Calmette-Guérin(BCG)intravesical instillation therapy for bladder cancer is accepted as an effective treatment, and infectious complications are rare. We present a case report on a patient with a common iliac pseudoaneurysm and a recurrent mycotic thoracoabdominal aortic aneurysm, who had a history of previous BCG therapy for bladder cancer. A 64-year-old man underwent emergency graft interposition of the right common iliac artery due to a ruptured pseudoaneurysm. Nine months after initial surgery, a biopsy of the pelvic retroperitoneal collection revealed epithelioid granuloma with caseous necrosis. Ziehl-Neelsen stain and mycobacterial culture were positive for acid-fast bacilli, which was identified as BCG(Tokyo 172). Diagnosis of BCG infection was delayed because of lack of clear clinical evidence of persistent infection. After 6 months of antituberculous chemotherapy the patient underwent resection of the mycotic thoracoabdominal aortic aneurysm and in situ reconstruction with a branched Dacron graft soaked in rifampicin because of its rapid growth. The pathological diagnosis was infectious aneurysm with sclerosis and epithelioid granuloma, however, acid-fast stain and culture were negative. Nine months later CT showed no recurrence of infectious aneurysm. Because the clinical presentation of BCG mycotic aneurysm is different from bacterial or fungal mycotic aneurysm, diagnosis by means of medical history checking and clinical presentation, in addition to surgical and medical combined treatment are important for its management.
  Jpn. J. Cardiovasc. Surg. 41:312-315(2012)

Keywords:infectious aneurysm, bladder cancer, BCG