The Recovery of an intravesical BCG-induced arthritis after RITUXIMAB treatment

BCG intra-vesical instillation is the standard of care for superficial bladder cancer at high risk of relapse and progression. Yet, this treatment can cause dysimmune complications. Osteoarticular manifestations related to BCG therapy are rare and frequently mild. We report a rare case of a severe form successfully treated with Rituximab.

Granulomatous Hepatitis Following Intra-Vesical Instillation of Bacillus Calmette–Guérin for Treatment of Bladder Cancer

Intra-vesical instillation of bacillus Calmette–Guérin (BCG) is an important treatment modality of superficial bladder cancer. It is usually well tolerated, although some adverse reactions can occur. One possible yet rare complication is granulomatous hepatitis, that is thought to be caused either by BCG infection or a hypersensitivity reaction to the bacillus. We present a case of a 79-year-old apparently immunocompetent patient who developed granulomatous hepatitis a few months after BCG administration for bladder cancer immunotherapy. It is important to notice that acid-fast smears and cultures are often negative, and these should not exclude diagnosis nor delay treatment. Our case highlights the importance of clinical suspicion and prompt initiation of appropriate treatment.

Recurrence rate of superficial bladder cancer with intravesical BCG and mitomycin.

Objective: To compare the recurrence rate of superficial transitional cell carcinoma of urinary bladder using intravesical BCG and Mitomycin-C. Study Design: Randomized Controlled Trial. Setting: Urology Department, Teaching DHQ Hospital, Gujranwala. Period: November 2018, to Sep, 2019. Material & Methods: Was carried out on total 270 patients, admitted with suspicion of urothelial tumors. They were grouped in Group A and B, comprising 135 in each group. Group A received BCG and Group B received Mtiomycin-C intravesically following TUR-BT. Results: Out of 270 patients male to female ratio was 3:1. Age range of patients was between 30 to 70 years with mean of 50.0± 13.1 and 552.3 ± 12.9 years in Group A and B respectively. Recurrence was noted in 05.38% and 15.38% patients in Group A and B respectively. Regarding side effects pyrexia was associated with BCG in 27.40% patients which were self-limited in 26.66% cases however required anti-tuberculosis therapy for six months in 0.74%. Whereas only 06.67% patients receiving Mitomycin had pyrexia. Dysuria occurred in 74% and frequency in 68% patients who received BCG. Whereas Dysuria occurred in 20% and frequency in 36.29% patients who received Mitomycin-C. However genital skin rash was more common (08.14%) in Mitomycin group than BCG. Conclusion: Keeping in mind less recurrence rate and bearable toxicity, it is concluded that BCG is superior to Mitomycin. This study suggests long term follow up is required to establish recurrence in the management of superficial bladder cancer.

PROGRESSION & RECURRENCE OF SUPERFICIAL BLADDER CANCER: A SINGLE-CENTER STUDY

Objective:To evaluate the progression and recurrence associated with supercial urinary bladder tumors. Materials and Methods: Progression and recurrence of supercial bladder cancer were studied in 100 patients over 3 years using a scoring system based on the six signicant clinical and pathological factors – number of tumors, tumor size, prior recurrence rate, T category, concomitant CIS, tumor grade.The data hence collected and then tabulated and was described using summary statistics. Results: 74% of patients used to smoke. 84 % were male while 16% were female. High-risk group patients lied over >70 yrs. age group. 43 patients are of low-risk risk among them only 13 (30.23%) patients recur without any progression seen. 19 patients are of intermediate-risk group among them 8(42.10%) recur while only 1 patient progress. 38 patients are of a high-risk group, recurrence seen in 20(52.63%) while 8(21.05%) patients progress to the next level. Conclusions:T1G3 patients >70 yrs age with tumors>3cm size tumor recur and progress frequently and it should be treated aggressively.