Mycobacterium bovisinfection of an aortobifemoral bypass graft withStreptococcus intermediussuperinfection after intravesical bacillus Calmette-Guerin immunotherapy for bladder cancer

Abstract

Background The Bacillus Calmette-Guerin (BCG) is a life-attenuated form ofMycobacterium boviswidely used as immunotherapy for localized bladder cancer. Adverse reactions to intravesical BCG instillations are rare. Case We describe a 70-year-old man with a history of an aortobifemoral bypass graft, placement of a synthetic mesh for treatment of a ventral hernia and, most recently, superficial bladder cancer treated with BCG therapy. Ten months after his final intravesical BCG instillation, he complained of fever and asthenia. After 12 months of investigation, he was diagnosed withMycobacterium bovisinfection of his aortobifemoral bypass graft and abdominal mesh, withStreptococcus intermediussuperinfection. The bypass graft was excised and replaced with an in situ arterial allograft, the abdominal mesh was removed, and treatment started with amoxicillin, isoniazid, rifampicin and ethambutol. Several additional vascular interventions were needed for allograft degradation, but 12 months after the final procedure, outcome was good. Discussion and Conclusions Among 35 cases of mycotic aneurysm reported after BCG therapy in the last 10 years, only one involved a vascular prosthesis. Surgical repair of such aneurysms using prosthetic grafts is commonly performed, associated with anti-mycobacterial treatment. Prognosis is poor with mortality of 14% (4/35) and a 26% rate of aneurysm recurrence under treatment (9/35).