BCG膀胱内注入療法後に発症した両側結核性精巣上体炎の1例

Abstract

72歳男性.患者は膀胱腫瘍(TCC)に対するBCG膀胱内注入療法施行後, 両側陰嚢腫大と疼痛が出現し, イソニアジド(INH), リファンピシン(RFP)投与を開始したが無効で著者らの施設へ入院となった.入院時, 尿培養は一般細菌, 結核菌とも陰性, ツベルクリン内皮反応は中等度陽性で, 陰嚢局所の炎症が高度であったため, 右精巣摘除および左精巣上体摘除術を施行した.病理組織学的に両側結核性精巣上体炎と診断され, 術後もRFP, INHを継続し, 経過は良好であった

We describe a case of bilateral tuberculous epididymitis that occurred two weeks after intravesical Bacillus Calmette-Guerin (BCG) instillation. A 72-year-old man received transuretheral resection of bladder transitional cell carcinoma in November 2000. Although he had no recurrence for about 4 years, cystoscopy revealed small papillary tumors in the bladder in September 2004. A course of 8 weekly intravesical instillations of BCG was started. After the second BCG instillation (160 mg) he had bilateral painful scrotal swelling. Although he was administered isoniazid (INH) and rifampicin (RFP), scrotal swelling got worse. Right orchiectomy and left epididymectomy was performed in December 2004. Histological diagnosis was bilateral tuberculous epididymitis. Postoperatively, he was administered INH and RFP and had no recurrence for 3 months.