Tuberculous spondylitis as a complication of intravesical bacillus Calmette-Guerin therapy.
We report a case of tuberculous spondylitis following intravesical bacillus Calmette-Guerin (BCG) instillation. A 90-year-old male physician living in South Africa received an uncomplicated 6-week course of intravesical BCG (Japanese 172 strain) for high grade superficial bladder carcinoma. He experienced a sudden onset of debilitating lower back pain 16 months following this treatment. A lytic lesion involving the anterior T11 and T12 vertebral bodies was diagnosed and subsequently biopsied. An acid-fast organism was isolated after 3 weeks of incubation and was confirmed through deoxyribonucleic acid probe hybridization as a mycobacterium. High performance liquid chromatography analysis speciated the organism as Mycobacterium bovis BCG, proving that it was acquired through the intravesical therapy.
Fishman
J R
JR
Department of Urology, University of California, School of Medicine, Davis, Sacramento.
Walton
D T
DT
Flynn
N M
NM
Benson
D R
DR
deVere White
R W
RW
D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D013166:Spondylitis / Q000382:microbiology*; D013904:Thoracic Vertebrae; D014399:Tuberculosis, Spinal / Q000382:microbiology*; D001749:Urinary Bladder Neoplasms / Q000628:therapy
D001500:BCG Vaccine