Bcg
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Prosthetic joint infection with Mycobacterium tuberculosis : case report A 66-year-old man developed prosthetic joint infection with Mycobacterium tuberculosis following treatment with BCG for urothelial bladder carcinoma. The man presented with tuberculosis of the prosthetic right-hip. He had urothelial bladder carcinoma, treated by transurethral resection of the tumour 2 years previously. Following the resection, he received intravesicular BCG [M. bovis BCG] instillations for a total of 6 doses. Following each instillation, he would exhibit shaking and chills; however, the symptoms had been self-limiting, and would resolve within 24 hours of each instillation. A few months after completion of BCG instillations, he started developing worsening pain over the prosthetic right-hip. He then underwent prosthesis revision in hospital. Peri-procedurally, joint effusion was noted and synovial fluid was subjected to bacterial and mycobacterial cultures. Post-operatively, he developed shaking and chills, similar to the previous occasions after BCG instillations. He additionally developed erythema around the incision over the next subsequent days; however, this resolved over time. He experienced recurrent, intermittent night sweats with a low-grade fever. An empirical therapy was given with doxycycline for suspected Lyme disease. Three weeks post incubation, mycobacterial cultures of the synovial fluid grew an acid-fast bacillus. A nucleic acid probe identified the isolate as Mycobacterium tuberculosis complex. Susceptibility testing of the isolate showed resistance to pyrazinamide with retained susceptibility to other first-line anti-tuberculosis medications. Based on the findings, a prosthetic joint infection secondary to M. bovis BCG was suspected. This was confirmed with PCR. He was treated with isoniazid, rifampin and ethambutol. Thereafter, the infection resolved. At the time of report, during the 3-month follow-up, he had no symptoms of a relapse. Storandt M, et al. Prosthetic joint infection: An extremely rare complication of intravesicular BCG therapy. BMJ Case Reports 12: No. 12, 2019. Available from: URL: http:// 803445731 doi.org/10.1136/bcr-2019-232809
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Reactions 18 Jan 2020 No. 1787
