A total hip replacement infected with mycobacterium bovis after intravesicular treatment with Bacille-Calmette-Guérin for bladder cancer.
An 86-year-old male presented with a loose total hip replacement (THR) ten years after implantation. At revision for anticipated aseptic loosening, watery pus was found in the joint and Bacille-Calmette-Guérin (BCG) was seen on culture. The bacterial strain was identified and was identical to the BCG used in the intravesicular treatment of superficial bladder carcinoma in this patient ten months earlier. After revision he received a full course of antituberculous treatment. The clinical and radiological results were excellent after follow-up for 30 months with his uncemented THR showing satisfactory incorporation. His inflammatory markers were normal and his Harris hip score was 95 points. The diagnosis of a tuberculous infection can be easily missed, but must be considered, especially if sterile pus is encountered.
Reigstad
O
O
Orthopaedic Department Rikshospitalet, N-0027 Oslo, Norway. ole.reigstad@rikshospitalet.no
Siewers
P
P
D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000283:Administration, Intravesical; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001500:BCG Vaccine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D009164:Mycobacterium Infections / Q000188:drug therapy*; D009163:Mycobacterium bovis; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine