BCG膀胱内注入療法に伴う局所及び全身性過敏反応にステロイドパルス療法が奏効した2例

Abstract

症例1は57歳女で, 再発膀胱腫瘍に対してTUR-Btを施行し, 再発予防のためBCG膀胱内注入療法を開始したが, 5回目注入後より咳, 痰, 眼瞼浮腫, 眼球結膜充血, 排尿時痛, 頻尿が出現した.抗結核薬, 抗生物質, 解熱鎮痛薬投与を行ったが改善しないため, BCGに対する過剰反応を考え, Methylprednisolone 1000mg/day静注よりのステロイドパルス療法を施行した.開始3日後には臨床症状は著明に改善し, 1週間後には無症状となった.退院後9ヵ月経過し, 再発はない.症例2は76歳男で, 再発膀胱癌に対してTUR-Btを施行し, 後療法としてBCG膀胱内注入療法を行ったが, 再度施行した際の5回目注入後より排尿時痛, 頻尿, 排尿困難が出現した.検査所見と併せてBCGに対する過敏反応を考え, ステロイドパルス療法を行った.1回目は効果不十分であったが, その2ヵ月後の再施行で症状は著明に改善し, 1週間後には無症状となった.退院後半年経過し, 再発はない

We have found steroid pulse therapy to be effective and safe for local and systemic adverse reactions of BCG therapy. Two cases are reported. Case 1: A 57-year-old woman with initial recurrence of urinary bladder carcinoma was treated with transurethral resection. The histopathological findings were transitional cell carcinoma (TCC), G2 > G1, pT1a. To prevent a second recurrence, she was administered Bacillus Calmette-Guerin (BCG) instillation therapy: 80 mg of BCG, (Tokyo strain) suspended in 40 ml of normal saline, instilled into her bladder weekly. After the fifth week of instillation, she was found to have a cough, sputum, edema of the eyelids, congestion of palpebral conjunctive, severe pain on micturition and pollakisuria. Although she was administered antituberculus, antibiotics and antiallergic drugs, all sign and symptoms were aggravated. Blood, urine and sputum cultures remained negative for mycobacterium. She was later diagnosed as having hypersensitive reactions against BCG and treated with steroid pulse therapy. The signs and symptoms mentioned above were decreased immediately and disappeared after a week. Case 2: A 76-year-old man with initial recurrence of urinary bladder carcinoma was treated with transurethral resection. To prevent a second recurrence, he was instilled the BCG six (6) times. Although no adverse reaction was observed, urinary cytology remained positive (class V) and small papillary tumor was detected at the dome of the bladder. Transurethral biopsy was then performed. The histopathological findings showed TCC, G3, CIS on the dome of bladder. Then he was again administered the same BCG instillation therapy. After the fifth instillation, he complained of severe pain of micturition, pollakisuria and dysuria. Although he was administered antibiotics and antiinflammatory drugs, all signs and symptoms were aggravated. Urine culture remained negative for mycobacterium. He was diagnosed as having hypersensitive reactions against BCG and was treated with two times of steroid pulse therapy. The signs and symptoms mentioned above were decreased immediately and disappeared after the second steroid pulse therapy.