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A Case of Interstitial Pneumonia Induced by Intravesical Administration of bacillus Calmette-Guerin(BCG).
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- Naoki Katsuhiko
- Departments of Medicine, School of Medicine, Keio University
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- Yamaguchi Kazuhiro
- Departments of Medicine, School of Medicine, Keio University
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- Soejima Kenzou
- Departments of Medicine, School of Medicine, Keio University
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- Aoki Takuya
- Departments of Medicine, School of Medicine, Keio University
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- Inoue Takasi
- Departments of Medicine, School of Medicine, Keio University
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- Satou Nagato
- Departments of Medicine, School of Medicine, Keio University
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- Shimada Hisato
- Departments of Medicine, School of Medicine, Keio University
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- Fukunaga Kouichi
- Departments of Medicine, School of Medicine, Keio University
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- Kudo Hiroyasu
- Departments of Medicine, School of Medicine, Keio University
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- Kanazawa Minoru
- Departments of Medicine, School of Medicine, Keio University
Bibliographic Information
- Other Title
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- ＢＣＧぼうこう内注入療法後の重症間質性肺炎の１例
Description
A 61-year-old man with superficial bladder cancer, which was detected after he complained of hematuria, was treated three times with intravesical BCG administration. Since liver dysfunction was detected thereafter, he was admitted to our hospital. Three days after admission, he complained of dyspnea on exertion associated with severe hypoxemia, as well as abnormal findings on chest X-ray, i. e. extensive bilateral lung densities. We performed bronchoscopic examination and obtained bronchoalveolar lavage fluid (BALF) and lung biopsy specimens (TBLB). In the BALF, a marked increase in the total cell number, particularly lymphocytes with a high CD4/CD8 ratio was noted. TBLB specimens revealed the lesions to be numerous non-caseating granulomas. We failed to obtain definite evidence of BCG in the sputum, urine, blood, and BALF. Instead, we found that a lymphocyte stimulation test for BCG (DLST) was strongly positive. Based on these findings, severe interstitial pneumonia probably induced by hypersensitivity against BCG, was diagnosed. Anti-tuberculous agents, and steroid-pulse therapy followed by oral administration of relatively low dose of steroid ameliorated the abnormal conditions, including chest X-ray film findings and hypoxemia. The population of lymphocytes and CD4/CD8 ratio in the BALF were reduced as well. Serious interstitial pneumonia was induced by the intravesical administration of BCG, which resulted in transitional changes in the BALF cell component.
Journal
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- The Japanese journal of thoracic diseases
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The Japanese journal of thoracic diseases 35 (12), 1383-1388, 1997
The Japanese Respiratory Society
