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Reminder of important clinical lesson
CASE REPORT
Mycobacterium bovis BCG spinal osteomyelitis in a patient with bladder cancer without a history of BCG instillation
  1. Asmita Gupte1,
  2. Anupama Matcha2,
  3. Michael Lauzardo1
  1. 1Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
  2. 2Division of Hospitalist Medicine, University of North Carolina Regional Physicians, High Point, North Carolina, USA
  1. Correspondence to Dr Asmita Gupte, asmita.gupte{at}medicine.ufl.edu

Summary

BCG has been used as intravesical immunotherapy for the treatment of bladder carcinoma. However, this treatment is not harmless and may lead to complications, with a reported incidence of systemic BCG infection ranging from 3% to 7%. We report a case of culture-proven Mycobacterium bovis (BCG) vertebral osteomyelitis in a 72-year-old patient with bladder carcinoma who was treated with intravesical mitomycin C but did not receive BCG. Cultures from biopsy recovered isolate resembling Mycobacterium tuberculosis biochemically, but resistant to pyrazinamide (PZA). The patient was originally started on a four-drug antituberculous regimen of isoniazid, rifampin, ethambutol and PZA. After genotypic analysis identified the organism as M. bovis (BCG), the regimen was changed to isoniazid and rifampin for 12 months. The patient responded well to this treatment. This case is unique as the patient received only intravesical mitomycin and did not receive BCG, implying the possibility of transmission from contaminated equipment.

  • nosocomial infections
  • bone and joint infections
  • tuberculosis

https://doi.org/10.1136/bcr-2018-224462

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    Footnotes

    • Contributors AG and AM are joint first authors as they have contributed equally to the manuscript. AG completed all the submissions and revisions and is the corresponding author. AG and ML contributed to the conception, drafting and critical revision of the article; closely supervised the management of the patient and were supervising physicians for the care of this patient; provided responses to the reviewer’s comments and did further literature searches to incorporate appropriate references as recommended by the reviewers. AM performed the initial literature review, integrated the data and wrote the initial manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.