A Case Report of Suspected Tuberculous Granuloma in the Kidney after BCG Perfusion Therapy for Urothelial Carcinoma of the Renal Pelvis

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  • Kobayashi, Shin
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Hori, Junichi
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Okazaki, Satoshi
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Hashizume, Kazumi
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Watanabe, Masaki
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Wada, Naoki
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Kita, Masafumi
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Azumi, Makoto
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Iwata, Tatsuya
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Matsumoto, Seiji
    The Department of Renal and Urologic Surgery, Asahikawa Medical University
  • Kakizaki, Hidehiro
    The Department of Renal and Urologic Surgery, Asahikawa Medical University

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Other Title
  • 両側腎盂癌に対するBCG 腎盂内灌流療法中に結核性肉芽腫が疑われる腫瘤を形成した1例
  • リョウガワジンウガン ニ タイスル BCGジンウナイカンリュウ リョウホウ チュウ ニ ケッカクセイ ニクゲシュ ガ ウタガワレル シュリュウ オ ケイセイ シタ 1レイ

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Abstract

A 66-year-old male patient was referred to our hospital for bilateral renal pelvic tumors. Ureteroscopic biopsy revealed urothelial carcinoma (UC) of low grade (G1) of the renal pelvis. Renal sparing treatment with systemic chemotherapy and percutaneous tumor resection was performed. However, during subsequent follow up, a recurrent tumor was foundon the left ureter. After ureteroscopic laser ablation of the tumor, Bacillus Calmette-Guerin (BCG) perfusion therapy (once a week, total 6 weeks) was performed via a single J ureteral catheter with no adverse events. Later, another recurrent recurrence was found on the right ureter, and was managed by ureteroscopic laser ablation followed by BCG perfusion therapy via a single J ureteral catheter. However, the patient developed high fever with chill from the day after initial BCG perfusion therapy on the right side. Although we started antibiotics, high fever continued. Then antituberculous drugs were administered and his condition was improved. Computed tomographic scan revealeda right renal mass 57 mm in diameter, which was consistent with tuberculous granuloma. The tuberculous granuloma persisted despite the continuation of anti-tuberculous drugs. In exceptional cases of upper tract UC such as single kidney andbilateral tumor, BCG perfusion therapy has been usedas adjunctive treatment to cure or prevent UC. However, dosages and administration methods of BCG perfusion therapy for upper tract UC still remain to be standardized. Serious adverse events after BCG perfusion therapy require prompt and proper management including the use of anti-tuberculous drugs.

Journal

  • Hinyokika Kiyo

    Hinyokika Kiyo 62 (1), 25-28, 2016-01-31

    泌尿器科紀要刊行会

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