Effectiveness of Steroid Pulse Therapy for Systemic Side Effects after Bacillus Calmette-Guérin Intravesical Instillation Therapy: A Series of Five Cases.

Case Reports in Urology Pub Date : 2021-07-09 eCollection Date: 2021-01-01 DOI:10.1155/2021/5548054
Tatsuya Umemoto, Jun Naruse, Yukio Usui, Hidenori Zakoji, Hideshi Miyakita, Akira Miyajima
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引用次数: 1

Abstract

Introduction: Bacillus Calmette-Guérin (BCG) instillation is an established therapy for the treatment of carcinoma in situ (CIS) of the bladder and prevention of recurrence after transurethral resection of bladder tumor noninvasive bladder cancer. However, serious systemic side effects may occur in less than 5% of patients with BCG intravesical instillation. Systemic side effects can sometimes be fatal and require early and accurate treatment. We describe five cases wherein steroid pulse therapy was effective for treating the systemic side effects after BCG intravesical instillation. Case Presentations. BCG intravesical instillation was used to prevent the recurrence of nonmuscle invasive bladder cancer and treat CIS of the bladder; the dose used was 40-80 mg each time, and the Tokyo strain was used. The patients developed fever, impaired consciousness, arthralgia, conjunctival hyperemia, and symptoms of cystitis. The median time from installation to side effect manifestation was 6 days (0-8). One to two courses of steroid pulse therapy were administered (1 course in 3 days), and the dose of methylprednisolone was 500-1000 mg/day. BCG sepsis was observed in one case; however, in the other four cases, one course of steroid pulse therapy showed a rapid improvement in symptoms. In the case of BCG sepsis, hemodialysis and mechanical ventilation were required because of septic shock and acute renal failure. Antituberculosis drugs (isoniazid, rifampicin, and ethambutol) were started promptly; however, no improvement was noticed. Two courses of steroid pulse therapy improved the patient's general condition, and hemodialysis and mechanical ventilation were no longer required. All patients survived without relapse of symptoms.

Conclusion: Our cases suggest that early steroid pulse therapy may be effective for rapid symptom improvement of the systemic side effects of BCG instillation therapy.

Abstract Image

类固醇脉冲治疗卡介苗-谷氨酰胺静脉滴注后全身副作用的疗效:附5例报告。
简介:卡介苗(Bacillus calmetet - gusamrin, BCG)灌注治疗膀胱原位癌(cancer in situ, CIS)和预防经尿道膀胱肿瘤切除术后非侵袭性膀胱癌复发是一种成熟的治疗方法。然而,小于5%的膀胱内注射卡介苗的患者可能出现严重的全身副作用。全身副作用有时可能是致命的,需要及早和准确的治疗。我们描述了5例类固醇脉冲治疗治疗卡介苗膀胱内灌注后的全身副作用是有效的。例演示。应用膀胱内灌注BCG预防非肌性浸润性膀胱癌复发及治疗膀胱CIS;每次剂量40 ~ 80 mg,采用东京菌株。患者出现发热、意识受损、关节痛、结膜充血和膀胱炎症状。从安装到出现副作用的中位时间为6天(0 ~ 8天)。给予1 - 2个疗程的类固醇脉冲治疗(3天1个疗程),甲基强的松龙的剂量为500- 1000mg /天。卡介苗败血症1例;然而,在其他四个病例中,一个疗程的类固醇脉冲治疗显示症状迅速改善。在卡介苗败血症病例中,由于脓毒性休克和急性肾功能衰竭,需要血液透析和机械通气。立即开始使用抗结核药物(异烟肼、利福平和乙胺丁醇);然而,没有发现任何改善。两个疗程的类固醇脉冲治疗改善了患者的一般情况,不再需要血液透析和机械通气。所有患者均存活,无症状复发。结论:我们的病例提示早期类固醇脉冲治疗可有效地快速改善卡介苗注射治疗的全身副作用。
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