INFECTION OF A RUPTURED AORTIC-ANEURYSM AND AN AORTIC GRAFT WITH BACILLE CALMETTE-GUERIN AFTER INTRAVESICAL ADMINISTRATION FOR BLADDER-CANCER

A case of aortic graft infection with bacille Calmette-Guerin (BCG) is described. The graft was placed during urgent repair of a ruptured ab dominal aortic aneurysm 2 years after intravesical administration of B CG for grade II transitional cell carcinoma of the bladder with associ ated carcinoma in situ, At the time of operation, no gross evidence of infection was found and pathologic examination of the aortic wall was unremarkable. Aortic graft infection with BCG was diagnosed 1 year af ter placement of the graft. Retrospective examination of formalin-fixe d, paraffin-embedded aortic wall and thrombus removed at the time of g raft placement by the polymerase chain reaction technique demonstrated the presence of mycobacterial DNA. The patient's condition improved w ith medical therapy during an observation period of 18 months with nea r total resolution on computed tomography scanning. Ultimately (20 mon ths later), an aortoenteric fistula developed that required graft remo val and axillobifemoral bypass.