BCG膀胱内注入療法後の結核性感染性腹部大動脈瘤破裂

Rupture of Tuberculous Infective Abdominal Aortic Aneurysm after Intravesical Bacillus Calmette-Guérin Instillation Therapy

Bacillus Calmette-Guérin（BCG）は膀胱上皮内癌の膀胱内注入療法（BCG膀注療法）として，再発率の低さから広く使用されている1）．われわれはBCG膀注療法1年3ヵ月後に，結核性感染性腹部大動脈瘤破裂を発症した症例を経験したので，文献的考察を加えて報告する．

The patient was a 74-year-old male who had undergone intravesical Bacillus Calmette-Guérin （BCG） instillation therapy for bladder cancer. He visited our hospital with chief complaints of fever and abdominal pain. Abdominal aortic aneurysmal rupture and iliopsoas muscle abscess were confirmed by computed tomography （CT）. We performed semi-emergency surgery, including replacement of the abdominal aorta with a synthetic graft, iliopsoas abscess debridement, and omentopexy. A rifampicin-bonded synthetic graft was used because of the possibility of tuberculous involvement after BCG instillation therapy. Examination of the tissues collected during surgery were positive for tuberculosis deoxyribonucleic acid （DNA） in a polymerase chain reaction （PCR）, and showed multiple giant cell granulomas with caseous necrosis, which both strongly suggested involvement of tuberculosis. Therefore, 4 types of antituberculous drugs were administered for 40 days. This case shows that an infective aneurysm should be suspected when fever and abdominal pain develop after intravesical BCG instillation therapy.