BCG-induced mycotic aneurysms involing the coronary and peripheral vasculature
The use of live attenuated intravesicular Bacillus Calmette-Guerin (BCG) therapy is a generally accepted safe and effective method for the treatment of superficial transitional cell carcinoma (TCC) of the bladder. Although rare, 2 years following initial therapy. Ultrasound and CT angiography (CTA) revealed a ruptured saccular aneurysm of the left popliteal artery as well as incidental bilateral common femoral artery aneurysms. Following endovascular treatment with a covered stent, the patient returned two months later with similar symptoms in the right knee. Ultrasound demonstrated a ruptured right popliteal aneurysm and the patient underwent subsequent covered stent placement followed by elective surgical repair of the common femoral aneurysms. Further workup with CTA revealed a partially thrombosed aneurysm arising from the mid left anterior descending (LAD) artery. The patient experienced a prolonged post-operative course with non-healing surgical groin wounds and the development of nonspecific systemic symptoms of fevers, chills and progressive weight loss. An extensive workup was performed, including a negative malignancy CT screen of the chest, abdomen and pelvis and serial negative blood cultures. Cultures obtained from the surgical groin wounds were positive for Mycobacterium Bovis, and the patient was initiated on a nine-month antimycobacterial course of isoniazid, rifampin and ethambutol. Including the present case, there has been a total of 32 reported cases of mycotic aneurysms as a complication from intravesicular BCG therapy, which we will review here. The majority of reported cases involve the abdominal aorta; however, this represents the first known reported case of a coronary aneurysm.