Težak hemofagocitni sindrom nakon intravezikalne instilacije BCG sa fatalnim ishodom

  • Stevan Stojanović University Clinical Center of Vojvodina, Clinic for Urology, Novi Sad, Serbia
  • Saša Vojinov University Clinical Center of Vojvodina, Clinic for Urology, Novi Sad, Serbia
  • Žarko Dimitrić University Clinical Center of Vojvodina, Clinic for Urology, Novi Sad, Serbia
  • Ivan Levakov University Clinical Center of Vojvodina, Clinic for Urology, Novi Sad, Serbia
  • Dimitrije Jeremić University Clinical Center of Vojvodina, Clinic for Urology, Novi Sad, Serbia
  • Tanja Lakić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
DOI: https://doi.org/10.2298/VSP210412065S
Ključne reči: bacillus calmette-guerin, limfohistiocitoza, hemofagocitna, insuficijencija više organa, mycobacterium xenopi, hirurgija, urološka, procedure

Sažetak


Uvod. Hemofagocitni sindrom (HS) nakon Bacillus Calmette-Guérin (BCG) imunoterapije se u svakodnevnoj praksi sreće izuzetno retko. Do sada su opisana samo tri slučaja HS u svetu. BCG imunoterapija se koristi u prevenciji recidiva površinskih tumora mokraćne bešike. Teške komplikacije nakon BCG imunoterapije su izuzetno retke. Prikaz bolesnika. Bolesnik star 55 godina premešten je na Kliniku za urologiju u lošem stanju nakon druge doze BCG imunoterapije, nakon transuretralne resekcije tumora mokraćne bešike. Načinjena je kompjuterizovana tomografija abdomena i male karlice, koja nije ukazivala na jasne znake oboljenja ili zatajenja organa. Primenjena je antituberkulozna, antibiotska, kortikosteroidna i simptomatska terapija kojom nije postignut zadovoljavajući efekat. Postavljena je sumnja na postojanje HS uzrokovanog primenom BCG imunoterapije. U daljoj hospitalizaciji došlo je do produbljivanja bolesti i razvoja komplikacija u vidu multiorganskog disfunkcionalnog sindroma. Smrt je nastupila šestog dana hospitalizacije. Posle smrti bolesnika, urađena je urinokultura koja je tri meseca nakon zasejavanja bila pozitivna na Mycobacterium xenopi. Zaključak. Sekundarni HS nakon BCG imunoterapije je izuzetno retko oboljenje, praćeno teškim opštim stanjem bolesnika, uz mnoštvo pretećih komplikacija koje mogu dovesti do smrtnog ishoda. Prikazali smo bolesnika kod koga se HS nakon BCG imunoterapije završio smrtnim ishodom. Ovo je jedinstven slučaj, jer je prvi put izolovan mogući uzročnik – mikobakterija.

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Objavljeno
2023/05/31
Broj časopisa
Vol. 80 Br. 05 (2023): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika