A novel view on the pathogenesis of complications after intravesical BCG for bladder cancer

Intravesical Bacillus Calmette-Guérin (BCG) is widely used for high-risk, non-muscle-invasive bladder cancer. We describe four cases which illustrate the spectrum of BCG-induced complications, varying from granulomatous prostatitis to sepsis. Considerable debate exists whether inflammation or infection is the predominant mechanism in the pathogenesis of BCG-disease. In two patients with systemic illness symptoms resolved first after adding prednisone, indicating a principle role for inflammation in systemic disease. In these patients with systemic disease, in vitro testing of T-cell responses and a Mycobacterial Growth Inhibition Assay were performed. 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, we think that immunological assays as described in this report may provide better insight into the pathogenesis of BCG-disease in individual patients, justifying further research.

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2018 May 17 [Epub ahead of print]

Manu P Bilsen, Krista E van Meijgaarden, Hanna K de Jong, Simone A Joosten, Corine Prins, Lucia J M Kroft, Jacqueline T Jonker, Stijn Crobach, Rob C Pelger, Tom H M Ottenhoff, Sandra M Arend

Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands., Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: ., Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands., Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands., Department of Urology, Leiden University Medical Center, Leiden, The Netherlands., Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: .