Aortoesophageal fistula caused by Mycobacterium bovis following intravesical Bacillus Calmette-Guérin therapy: a case report and literature review
Abstract
BACKGROUND: Intravesical Bacillus Calmette-Guérin (BCG) therapy is an established treatment for non-muscle-invasive bladder cancer, involving direct instillation of a solution containing attenuated Mycobacterium bovis into the bladder. Although generally well-tolerated, rare vascular complications, including mycotic aneurysms and aortoenteric fistulas, have been reported. CASE PRESENTATION: We report the case of a 76-year-old Japanese man who developed an aortoesophageal fistula three years after completing intravesical BCG therapy for superficial bladder carcinoma. The patient initially presented with bilateral lower limb pain following thoracic endovascular aortic repair. During hospitalization for lumbar pyogenic spondylitis, M. bovis was isolated from both sputum and spine biopsy cultures and confirmed using single-nucleotide polymorphism analysis. Despite the initiation of antimycobacterial therapy with rifampicin, isoniazid, ethambutol, and levofloxacin, he developed hematemesis and upper abdominal pain. Computed tomography findings were highly suggestive of an aortoesophageal fistula. The patient underwent successful surgical repair followed by a prolonged course of antimycobacterial therapy for at least ten months. CONCLUSIONS: To our knowledge, this is the first documented case of an aortoesophageal fistula caused by M. bovis following intravesical BCG therapy. Clinicians should maintain a high index of suspicion for this life-threatening complication in patients…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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