TITLE:
Late and Reversible Kidney-Lung Failure after Intra-Bladder BCG Therapy
AUTHORS:
Olivier Mat, Rim Kada, Patrick Philippart, Quentin Mat, Steffy Larroze, Myriam Remmelink, Selda Aydin, Vincent Colombie
KEYWORDS:
Corticosteroids; Hemodialysis; Intravesical BCG; Mycobacterium bovis; Pulmonary Granulomatosis; Renal Failure; Tubulointerstitial Nephritis; Urothelial Carcinoma
JOURNAL NAME:
Open Journal of Nephrology,
Vol.3 No.3,
September
9,
2013
ABSTRACT:
We observed a 76-year-old man who presented “acute
kidney-lung failure” 9 months after intravesical Bacillus Calmette-Guérin
(BCG) adjuvant treatment for a T1 bladder cancer. He had inflammatory
infiltration on chest radiography and required dialysis for acute renal
failure. A percutaneous renal biopsy was performed and revealed tubulointerstitial
nephritis with a moderate eosinophilic infiltrate without granulomatous lesion.
After a few days, an open lung biopsy was also done due to
respiratory deterioration. The anatomopathologic specimen demonstrated moderate
fibrosis with lympho-neutrophilic infiltration and few aspecific granulomatous lesions without
caseous necrosis. Sarcoidosis was suspected and high dose oral
methylprednisolone was started. Three weeks later, Mycobacterium bovis was identified by Polymerase Chain Reaction on open lung biopsy. He responded
well to steroids and tuberculostatic tri-therapy. After one month of
immunosuppressive treatment, renal function was resolved and
hemodialysis could be discontinued. Despite the frequent use of adjuvant BCG
immunotherapy, systemic complications such as hepatitis, pneumonitis, spondylodiscitis
or multiorgan failure are rare (