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. 2013;4(9):768-70.
doi: 10.1016/j.ijscr.2013.05.017. Epub 2013 Jun 14.

Post-intravesical BCG epididymo-orchitis: Case report and a review of the literature

S G Parker  1 , S S Kommu
Affiliations

Post-intravesical BCG epididymo-orchitis: Case report and a review of the literature

S G Parker et al. Int J Surg Case Rep. 2013.

Abstract

Introduction: Bladder cancer is a significant epidemiological disease. It is managed by primary resection and on-going surveillance for recurrent disease. Intravesical BCG therapy is used in superficial carcinomas to lower the incidence of recurrence and prolong the time to recurrence. BCG therapy is not without its rare but serious side effects.

Presentation of case: A 75-year-old man presented to the urologist with right testicular pain, after four previous TURBT operations, two courses of intravesical BCG therapy and one STAT dose of intravesical mitomycin. The patient's USS testis showed hypoechoic lesions in the right testis. An orchiectomy was carried out due to the possibility of the USS showing a malignancy. Histology confirmed BCG epididymo-orchitis.

Discussion: This patient presented with testicular pain fifteen months after the cessation of BCG therapy. Clinicians need to be aware of the potentially long dormancy periods for BCG infections, and their complications, as well as the acute infective BCG presentations. The literature is reviewed and shows the wide range of infective BCG presentations from acute disseminated sepsis to insidious focal infections such as parotiditis and discitis.

Conclusion: This case report demonstrates that due to the delayed and gradual onset of symptoms, BCG infections are difficult to diagnose. The report and the review remind surgeons to keep BCG infection amongst their differentials when treating patients who present after BCG therapy.

Keywords: BCG; Bladder; Cancer; Complications; Intravesical; Therapy.

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Figures

Fig. 1
Fig. 1
USS right testis; longitudinal and transverse views. Multiple hypoechoic areas were demonstrated within the right testis. The head of the right epididymis appears enlarged and bulky. There is a hypoechoic lesion with solid areas measuring 1.16 cm × 1.22 cm seen within the tail of the right epididymis. A small hydrocoele was demonstrated.
See this image and copyright information in PMC

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