FARUK ÇİÇEKCİ, Mustafa BÜYÜKCAVLAK, YEŞİM ŞERİFE BAYRAKTAR, JALE BENGİ ÇELİK

Transüretral mesane tümörü rezeksiyonu sonrası bacillus calmette-guérin (bcg) immünoterapisine bağlı nadir bir komplikasyon: Akut solunum yetmezliği ve sepsis

Yüzeyel mesane kanserinde intravezikal BCG tedavisi güvenli ve etkili olarak kabul edilir. Sistemik komplikasyonlar nadir de olsa fark edilmediğinde yaşamı tehdit edici olabilir. Bu olgu sunumunda, intravezikal BCG tedavisinden sonra sistemik enfeksiyonun erken ve etkili tedavisinin önemini vurgulamak istedik. Olgu: 52 yaşında yüzeyel mesane kanseri teşhisi konulan ve 4 kez Trans Uretral Rezeksiyon-Mesane Tümörü(TUR-MT) operasyonu uygulanan erkek hastaya BCG tedavisi planlanmış. BCG'nin üçüncü kür tedavisinden 2 hafta sonra, hasta yüksek ateş, kırıklık, solunum sıkıntısı nedeniyle yoğun bakım ünitesine yatırıldı. Hastayahemen anti-tüberküloz tedavisi başlandı. Yoğun bakım ünitesinde genel durumu bozulan hasta mekanik ventilatöre bağlandı. Hastada pozitif inotropik tedaviye cevap vermeyen hipotansiyon ile birlikte akut böbrek yetmezliği gelişti ve hemodiyaliz tedavisi başlandı. Ancak 23. günde, kardiyak arrest geçiren hasta tüm müdahalelerecevap vermedi ve eksitus oldu. Sonuç: BCG tedavisinin sistemik yan etkileri nadirdir, ancak hızlı ve etkin bir şekilde tedavi edilmezse yaşamı tehdit eder. Bu nedenle, BCG tedavisinden sonra ateş, taşikardi gibi sistemik bulgular görüldüğünde, anti-tüberküloz tedavisi hızla başlatılmalıdır. Kortikosteroidlerin tedaviye eklenmesi yapılan çalışmalarda önerilmektedir.

Intravesical Bacillus Calmette-Guérin (BCG) therapy in superficial bladder cancer is considered safe and effective. Systemic complications, although rare, can be life-threatening if not noticed. In this case, we wanted to emphasize the importance of early and effective treatment of systemic infection after intravesical BCG therapy. Case: A 52-year-old male patient was diagnosed with superficial bladder cancer. He had four times Trans Urethral Resection-Bladder Tumor (TUR-BT) operation. Two weeks after the third cure of BCG, the patient was admitted to intensive care unit due to high fever, malaise, respiratory distress. The patient was immediately treated with anti-tuberculosis treatment.In the intensive care unit, the patient whose general condition was disrupted was connected to the mechanical ventilator. Positive inotropic treatment resistant hypotension, acute renal failure occurred. Hemodialysis treatment started. But, on the 23th day the patient who had undergone cardiac arrest and did not respond to the intervention was considered to exitus. Conclusion: Systemic side effects of BCG therapy are rare but life threatening if not treated quickly and effectively. Therefore, when systemic findings such as fever, tachycardia are seen after BCG treatment, anti-tuberculosis treatment should be started quickly.The addition of corticosteroids to the treatment is recommended in studies.

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