Mycobacterium bovisprosthetic joint infection following intravesical instillation of BCG for bladder cancer

Abstract

A 91-year-old man with a history of intravesicular BCG therapy for recurrent bladder cancer and bilateral total hip arthroplasty (THA) presented with left hip pain. He was noted to have a fluid collection over the left lateral hip and hip X-ray showed loosening of the prosthetic hip stem indicative of a prosthetic joint infection (PJI). He subsequently underwent removal of the THA and insertion of an antibiotic spacer. He was discharged on intravenous ceftriaxone for presumed culture negative PJI. Intraoperative acid fast bacillus culture later grew Mycobacterium tuberculosis complex, which was then differentiated to M. bovis. The M. bovis infection was thought to be a complication of the patient’s prior BCG therapy. He was initially started on isoniazid, rifampin, pyrazinamide and ethambutol pending cultures and sensitivities; pyrazinamide was discontinued after M. bovis was isolated on culture and susceptibility data confirmed the expected inherent resistance of M. bovis to pyrazinamide. The patient underwent successful THA revision and remains symptom-free at 1 year.

Mycobacterium bovis Infection of a Deep Brain Stimulation System Following Intravesical Bacillus Calmette-Guérin (BCG) Instillation

“…In literature, there is a variation in treatment duration ranging from six months to two years; only one case was treated during four months (ICD). The rationale for this variation is not quite clear but might depend on clinical recovery of the individual patients and/or negative culture [15,20,21,22]. For the four patients in whom the implant was not removed, antibiotic treatment lasted at least 12 months.…”

Case of Mycobacterium bovis Prosthetic Joint Infection from Intravesicular BCG

“…Disseminated BCG infections of prosthetic joints are distinctly rare. A review of Google Scholar and PubMed reveals that approximately 14 cases have been reported in the literature, including the current case [9][10][11][12][13][14][15][16][17]. Joints involved were predominantly hips (10 cases), total knee arthroplasty (3 cases), and one case of shoulder prosthetic joint infection [16] are reported.…”

Delayed Diagnosis of Mycobacterium bovis bacillus Calmette-Guérin Periprosthetic Joint Infection Following Total Knee Arthroplasty

“…Herein we present a case of a challenging workup, diagnosis, and treatment of a PJI due to Bacillus Calmette-Guérin (BCG), administered 3 years prior to TKA in the treatment of bladder cancer. A prior report has described a case of BCG, employed in the treatment of nonmuscle-invasive bladder cancer, which disseminated and led to PJI [ 11 ], though this has not been otherwise frequently described in the arthroplasty literature. The clinical course, diagnostic, and treatment challenges in this case will inform surgeons and clinicians of this rare PJI etiology.…”