BCG膀胱内注入療法後に発症した結核性精巣上体炎

A case report of tuberculous epididymitis after intravesical bacillus Calmette-Guerin instillation

症例は75歳，男性。表在性膀胱癌に対し経尿道的膀胱腫瘍切除術を施行した。その後，BCG膀胱内注入療法を施行した。初回のBCG膀胱内注入後に左陰囊部痛，硬結，および陰囊皮膚の自壊を認めた。結核菌PCR陽性，尿中抗酸菌培養陽性であったため，結核性精巣上体炎と診断した。抗結核化学療法で改善なく，左陰囊内容摘除および陰囊皮膚合併切除術を施行した。術後，抗結核化学療法（rifampicin＋isoniazid）を3か月間行い，現在まで再発徴候を認めていない。

A 75-year-old man received transuretheral resection（TUR-BT）for bladder cancer. After TUR-BT,he underwent intravesical instillation of BCG. He suffered from left scrotal pain after the first administration of BCG. At the same time,left scrotal induration and pus discharge developed. Urine examination revealed acid-fast bacilli,which proved shown to be tubercle bacilli. Chemotherapy for tuberculous（TB）with rifampicin,isoniazid and ethambutol was initiated. Which however,was of no effect. Therefore we performed left orchiectomy and scrotal skin resection. Histopathological examination showed TB epididymitis. Postoperative chemotherapy consisting of isoniazid and rifampicin was performed for three months,and he has no sign of recurrence.