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Systemic BCG with Pneumonitis

Systemic BCG with Pneumonitis. By Carrie Fitzgerald Uro 1. Urology consult for patient with irritative symptoms R/O UTI 81 year old African American male, appears younger then stated age

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Systemic BCG with Pneumonitis

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  1. Systemic BCG with Pneumonitis By Carrie Fitzgerald Uro 1

  2. Urology consult for patient with irritative symptoms R/O UTI 81 year old African American male, appears younger then stated age • Presents with c/o irritative voiding sxs for 24 hr. daughter noticed diaphoresis acute change MS; dysuria, fever 103 brought pt to ER. • Pt seen by medicine and started on empiric parenteral antibiotic treatment after urine culture obtained • Found out 72 hours later patient was post BCG intravesical treatment, including dysuria and frequency and urology consult obtained PMHx Superficial Bladder Ca sp BCG 6 week induction; maintenance dose 72 hr prior; ho sxs post intraves CaP s/p RRP Dementia HTN Meds : Aricept, Cozaar , Enablex, HCTZ, Norvasc, Colace Soc Hx: Tob 30 pack yr, no ETOH, no illicits FamHx: no GU malignancies Hospital day 3

  3. VS 100.2 82 22 154/86 96% • AAOx2, NAD • CTAB, S1S2 no murmurs • Soft, NT no sp ttp, no CVA tenderness • Uncircumsize. Nl Descended. Foley gravity, urine clear, yellow, no meatal erosion bld. Prostate absent. • WBC 5.4 (13.5/ band % 13 on admit) • H/H 11.4/32 12.9/36.4 on admit • BUN 13 Cr 1.16 (35/2.47 on admission) • AST 93 ALT 94AlkP92 • T bili2.26 D bili1.18 • Sterile pyruria (W 20-50) • CXR Labs and Exam

  4. Assessment: UTI vs BCG side effect vs systemic BCG Hyperpyrexia AKI Hyperbilirubinemia Anemia HTN • Bld/U Tb cx • ID consult • Levaquin, INH • WBC Scan • Abd US • CT scan abd/pel • Renal cyst /abscess drainage Assessment and Plan

  5. Bld Cx : no growth 5 d • Ucx : no growth 24 hrs • Misc Cx : R renal cyst aspirate neg for AFB, aerobes, anaerobe Episodes of fever (Tmax 104.4) and diaphoresis Q8-12 hour Expiratory wheezes; O2 sat80% Rigors Change in MS Results and PE

  6. Assessment Disseminated BCG +/- hypersensitivity rxtn Respiratory distress Hepatitis BCG vsPharm Hyperpyrexia Anemia – AOCD w/folate def Urinary incontinence AKI HTN WBC 9.6 (11/band% 25 hosp day 17) H/H 8.3/24 (7.5/21.9 hosp 17) BUN 21 Cr 1.38 AST 162 ALT 78 AlkP102 T bili3.01 D bili1.93 PSA < 0.01 HepBab/Ag - neg Hospital Day 13

  7. Rifampin 600 mg po Qd • Pyrazinamide 1000 mg po Qd • Isoniazid 300 mg po Qd • Levaquin 250 mg po Qd • Stopped Pyrazinamide on 10/27 started Ethambutol 1600mg po daily • Zosyn 3.375 g x1 • Vancomycin 750 mg x 1 • Rocephin 1g x1 • Azithromycin 500 mg x1 Treatment

  8. Lamm consult • Started Solumedrol 40 mg IVP Q 6 hours hosp day 17 with slow taper • Discharged to rehab hosp day 20 In Addition

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