J Yeungnam Med Sci.  2023 Oct;40(4):430-434. 10.12701/jyms.2022.00850.

Intravesical bacillus Calmette–Guérin-induced myopathy presenting as rhabdomyolysis: a case report

• Lee CH
• Choi BJ
• Kim JH
• Yang TW
• Kim GJ
• Shin HY
• Kim SH
• Kim SW

• KMID: 2547369
• DOI: http://doi.org/10.12701/jyms.2022.00850

Abstract

Intravesical bacillus Calmette–Guérin (BCG) instillation is an adjuvant treatment for non–muscle-invasive urinary bladder cancer. Although most complications associated with BCG immunotherapy are mild and self-limiting, rare albeit serious complications have been reported. Only a few cases of BCG-related rhabdomyolysis have been reported. In this study, we present the case of a 72-year-old woman who developed severe weakness and hyperCKemia following intravesical BCG instillation. A muscle biopsy was performed, and a diagnosis of drug-induced myopathy was made.

Keyword

BCG vaccine; Intravesical administration; Muscular diseases; Rhabdomyolysis

Figure

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  Fig. 1. Time course of the treatment for urinary bladder cancer and onset of symptoms in weeks. BCG, bacillus Calmette–Guérin.

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  Fig. 2. Whole-body muscle magnetic resonance imaging of the present case. Axial T2-weighted modified Dixon images show symmetric bilateral hyperintense signal of the muscle (arrows) in the (A) upper arm, (B) thigh, and (C) lower leg.

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  Fig. 3. Immunohistochemistry of the muscle biopsy. (A) Hematoxylin and eosin stain (×400) shows increased size variability and degeneration with mild lymphocytic infiltration. (B) Myosin ATPase stain (×100) at pH 4.3 shows type 1 fiber atrophy. In immunohistochemical stain of sarcolemma, (C) major histocompatibility complex-1 (×100) and (D) C5b–C9 (×100) are faintly expressed.

Reference

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