Psoas Abscess Following Intravesical Bacillus Calmette-Guerin for Bladder Cancer: A Case Report

Hakim, Samuel; Heaney, John A.; Heinz, Tad R.; Zwolak, Robert W.

doi:10.1016/s0022-5347(17)35432-0

Cited by 39 publications

(17 citation statements)

References 11 publications

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“…Vertebral osteomyelitis in these patients is thought to result from hematogenous dissemination of BCG infection. [1011151725] Although an immunity-mediated hypersensitivity reaction could theoretically underlie the granulomatous inflammatory response in the spine, identification of M. bovis in all cases (including our case) strongly suggests an actual dissemination of the bacillus from the bladder to the spine. Vascular dissemination and large-vessel mycotic vasculitis have been described following intravesical BCG immunotherapy, lending further support to hematogenous spread as a pathogenetic mechanism.…”

Section: Discussionmentioning

confidence: 74%

Mycobacterium bovis spondylodiscitis after intravesical Bacillus Calmette-Guérin therapy

Obaid

Weil²,

Rahme³

et al. 2011

Surg Neurol Int

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Background:Intravesical instillations of live-attenuated Bacillus Calmette-Guérin (BCG) are a well-known and effective method for prevention and treatment of bladder carcinoma and carcinoma in situ. Although considered a safe procedure with rare side effects, local and systemic complications may occur. While long bone ostemolyelitis has been well described, very few reports of BCG spondylodiscitis exist in the literature.Case Description:A 67-year-old man developed low back pain, anorexia, and weight loss 11 months after a 6-week course of intravesical BCG instillations for the treatment of bladder carcinoma in situ. Imaging studies revealed L1-L2 spondylodiscitis with epidural and bilateral psoas abscesses. Tissue cultures obtained by percutaneous computed tomography-guided aspiration were positive for Mycobacterium bovis. Despite triple antituberculous therapy (isoniazid, rifampin, and ethambutol), clinical and radiological progression occurred. Therefore, L1 and L2 corpectomies with extensive debridement were performed, followed by 360° anterior-posterior instrumented fusion. After 20 months of follow-up, the patient remains asymptomatic and recurrence-free.Conclusion:Mycobacterium bovis spondylodiscitis is a rare complication of intravesical BCG therapy. Although medical therapy with antituberculous agents is the first-line treatment, surgical decompression, debridement, and stabilization may be necessary in refractory cases.

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Section: Discussionmentioning

confidence: 74%

Mycobacterium bovis spondylodiscitis after intravesical Bacillus Calmette-Guérin therapy

Obaid

Weil²,

Rahme³

et al. 2011

Surg Neurol Int

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“…Seelig et al 26 reported a case series of 8 patients with BCG mycotic vascular infections of large arteries. Metastatic complications such as infection of implantable devices, 27 prosthetic joints, 28 and psoas abscesses 29,30 have also been described. Osteomyelitis after BCG vaccination is rare, with an incidence of 1 in a million, with most incidences occurring in long bones.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium bovis Bacillus Calmette-Guérin Vertebral Osteomyelitis After Intravesical Bacillus Calmette-Guérin Used for Bladder Cancer

Vindenes¹,

McGowan²,

Woo-Roderick³

et al. 2015

Infectious Diseases in Clinical Practice

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Background: Bacillus Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis and has been used for intravesical treatment of superficial bladder cancer since 1976. Systemic complications of intravesical BCG are rare, and vertebral osteomyelitis has only been described in 10 prior cases worldwide.Case: A 64-year-old white man with benign prostatic hyperplasia was diagnosed with transitional cell bladder cancer and underwent transurethral resection of bladder tumor. He received perioperative mitomycin C followed by a 6-week course of intravesical BCG. Recurrent bladder cancer was noted on follow-up cystoscopy and he was started on a second 6-week course of BCG. Before the second intravesical BCG, he developed night sweats and severe progressive back pain with bilateral lower extremity weakness. Magnetic resonance imaging of the spine revealed a T11 to T12 vertebral body destruction with discitis, and biopsy revealed M bovis BCG. He received therapy with isoniazid, rifampin, capreomycin, as well as ethambutol and, later, additional drugs (cycloserine, moxifloxacin) secondary to clinical and radiographic progression of disease. He underwent a T11 to T12 vertebrectomy and continued on isoniazid, rifampin, cycloserine, and moxifloxacin for a total of 12 months postoperatively.Conclusions: Mycobacterium bovis BCG osteomyelitis is a rare complication of intravesical BCG therapy for bladder cancer and may occur as a solitary site of infection. A high degree of suspicion is important in patients with osteomyelitis with a history of transitional cell cancer managed with immunotherapy using BCG instillations.

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“…Risk factors for complications from BCG instillation include traumatic catheterization, urethral injury during BCG instillation, bladder biopsy, hematuria, active infection, immunosuppression, bladder outlet obstruction, radiation cystitis, and transurethral resection of the prostate and deep bladder tumor within two weeks of instillation. [6][7][8][9][10][11] BCG organisms have been documented in the bladder up to 16.5 months after completion of BCG intravesical instillation therapy. 6 Long lasting and persistent BCG DNA in the bladder wall after intravesical BCG therapy may account for long-term immuneactivation and immune anticancer effects, and may explain why patients are still at risk of disseminated infection for months and even years after BCG therapy.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium Bovis BCG Strain Osteomyelitis Masquerading as Spinal Metastasis from Bladder Cancer

Chuda

Poddutoori²,

Veldhuizen³

2012

kjm

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Psoas Abscess Following Intravesical Bacillus Calmette-Guerin for Bladder Cancer: A Case Report

Cited by 39 publications

References 11 publications

Mycobacterium bovis spondylodiscitis after intravesical Bacillus Calmette-Guérin therapy

Mycobacterium bovis spondylodiscitis after intravesical Bacillus Calmette-Guérin therapy

Mycobacterium bovis Bacillus Calmette-Guérin Vertebral Osteomyelitis After Intravesical Bacillus Calmette-Guérin Used for Bladder Cancer

Mycobacterium Bovis BCG Strain Osteomyelitis Masquerading as Spinal Metastasis from Bladder Cancer

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