Postoperative spondylodiscitis caused by Mycobacterium bovis BCG: a case study

Rätsep, Tõnu

doi:10.1016/j.spinee.2012.10.024

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…Clinicians should be aware that traumatic intravesicular BCG therapy is not the sole mechanism of M. bovis spinal tuberculosis in adults. Alternative routes of entry include bovine contact and unpasteurized milk ingestion [ 25 - 27 ], adolescent BCG vaccination [ 28 ], intralesional BCG for non-bladder carcinoma [ 29 ], and incidental occupational exposure during BCG administration [ 30 ]. These cases have a wider age range (31-72 years old), frequently affect both sexes, and may involve cervical [ 30 ] or sacral [ 25 ] vertebrae.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterial Osteomyelitis of the Spine Following Intravesical BCG Therapy for Bladder Cancer

Mackel¹,

Burke²,

Huhta³

et al. 2016

Cureus

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Osteomyelitis is an infection of the bone that can involve the vertebral column. A rare cause of vertebral osteomyelitis is Mycobacterium bovis after intravesical Bacillus Calmette-Guerin (BCG) therapy for transitional cell carcinoma of the bladder. In this report, we describe the case of a 64-year-old male presenting with constitutional symptoms, progressive thoracic kyphosis, and intractable T11 and T12 radiculopathies over the proceeding six months. A CT scan revealed erosive, lytic changes of the T12 and L1 vertebrae with compression of the T12 vertebra. An MRI demonstrated T11-12 osteomyelitis with intervening discitis and extensive paraspinal enhancement with a corresponding hyperintensity on a short tau inversion recovery (STIR) sequence. A needle aspiration grew out Mycobacterial tuberculosis complex that was pansensitive to all antimicrobial agent therapies, except pyrazinamide on culture, a finding consistent with an M. bovis infection. The patient’s infection and neurologic compromise resolved after transthoracic T11-12 vertebrectomies with decompression of the spinal cord and nerve roots as well as T10-L1 instrumented fusion and protracted antimicrobial therapy. The epidemiology and natural history of M. bovis osteomyelitis are reviewed and the authors emphasize a mechanism of vertebral inoculation to explain the predilection of M. bovis osteomyelitis in males after intravesical BCG therapy.

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