Original articleUveitis in a Patient Treated with Bacille-Calmette-Guérin: Possible Antigenic Mimicry of Mycobacterial and Retinal Antigens
Section snippets
Case Report
A 72-year-old woman was referred by an ophthalmologist to the authors' outpatient department with a bilateral granulomatous anterior uveitis, which had been ongoing for 3 to 4 days. The patient reported painless blurred vision, initially in her left eye. Otherwise, there was no history of previous uveitis. Findings were recorded according to the Standardization of Uveitis Nomenclature criteria. Initially, best-corrected visual acuity was 0.8 in the right eye and 0.6 in the left eye. Both eyes
Peptides and Protein Antigens
Retinal soluble antigen (S-Ag) and interphotoreceptor retinoid-binding protein (IRBP) were prepared from bovine eyes as described,15, 16 and the purity was controlled by gel electrophoresis. Recombinant cellular retinal-binding protein (CRALBP) was obtained and purified as described.17 Chicken ovalbumin (OVA) was obtained from SIGMA (Deisenhofen, Germany), and tuberculin (PPD) and tetanus toxoid (TT) were gifts from Aventis (Marburg, Germany). Custom peptides were purchased from Biotrend
In Vitro Lymphocyte Responses
The patient's lymphocytes were collected when clinical disease had subsided completely. Proliferation exceeding the medium control by 2-fold was observed only for PPD, TT, IRBP, and R16 (Fig 3). Elevated cytokine responses were detected more frequently, revealing T-helper 1 (Th1)-type reactivity with secretion of IFN-γ to all tested retinal antigens and peptides from S-Ag and IRBP as well as to chicken ovalbumin and PPD (Fig 3). Despite the negative tuberculin skin response of the patient, high
Discussion
Bacille Calmette-Guérin instillation is regarded as the most effective treatment and prophylaxis for noninvasive bladder cancer. Live mycobacteria attach to and invade the bladder tumor cells using fibronectin and integrins and induce inflammation with infiltration of macrophages, T and B lymphocytes, and natural killer cells as well as upregulation of proinflammatory cytokines including IL-1, IL-2, IL-5, IL-6, IL-8, IL-10, IL-12, IL-18, IFN-γ, tumor necrosis factor-α, and granulocyte-monocyte
References (35)
- et al.
Panuveitis following intravesical bacille Calmette-Guerin therapy [letter]
J Fr Opthalmol
(2006) - et al.
Internalization of bacille Calmette-Guerin by bladder tumor cells
J Urol
(1991) - et al.
Role of fibronectin in intravesical BCG therapy for superficial bladder cancer
J Urol
(1988) - et al.
Antibody reactivity to mycobacterial 65 kDa heat shock protein: relevance to autoimmunity
J Autoimmun
(1995) - et al.
Comparative analysis of HLA class I antigens in pulmonary sarcoidosis and tuberculosis in the same ethnic group
Mayo Clin Proc
(2003) Tuberculosis
Curr Opinion Ophthalmol
(2007)- et al.
S antigen-induced experimental autoimmune uveo-retinitis in rats
Curr Eye Res
(1981) - et al.
Influence of BCG vaccine strain on the immune response and protection against tuberculosis
FEMS Microbiol Rev
(2008) - et al.
Adverse drug reactions of intravesical bacillus Calmette-Guerin instillation and risk factors of the development of adverse drug reactions in superficial cancer and carcinoma in situ of the bladder
Int J Urol
(2005) - et al.
Chronic anterior uveitis following bacille Calmette-Guerin vaccination: molecular mimicry in action?
J Pediatr Ophthalmol Strabismus
(2008)
Arthritis and iritis after BCG therapy for bladder cancer
J Rheumatol
Arthritis and iritis after bacillus Calmette-Guerin therapy [letter]
J Rheumatol
Severe uveitis followed by reactive arthritis after bacillus Calmette-Guerin therapy [letter]
J Rheumatol
Bilateral uveitis after intravesical BCG immunotherapy for bladder carcinoma [letter]
Br J Ophthalmol
Chorioretinitis induced by intravesical bacillus Calmette-Guerin (BCG) instillations for urinary bladder carcinoma
Klin Monatsbl Augenheilkd
Uveitis and vitiligo associated with BCG treatment for malignant melanoma
Surgery
Bilateral panuveitis and optic neuritis following bacillus Calmette-Guerin (BCG) vaccination [letter]
Acta Paediatr
Cited by (67)
Noninfectious Uveitis Risk After COVID-19 Vaccination: A Nationwide Retrospective Cohort Study
2024, American Journal of OphthalmologyThe immune response in tubercular uveitis and its implications for treatment: From anti-tubercular treatment to host-directed therapies
2023, Progress in Retinal and Eye ResearchAutoimmune disorders caused by intravesical bacillus Calmette-Guerine treatment: A systemic review
2023, Autoimmunity ReviewsAntigenic mimicry – The key to autoimmunity in immune privileged organs
2023, Journal of AutoimmunitySARS-CoV-2 vaccination and uveitis: Are they linked?
2022, Annals of Medicine and Surgery
Available online: October 7, 2009.
Manuscript no. 2009-129.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by the German Research Council (DFG), SFB 571 (Projects D3 [GW] and A5 [CAD]).