Case Study of the MonthBacillus Calmette-Guérin Osteomyelitis Mimicking Spinal Metastasis from Urothelial Cell Carcinoma of the Bladder
Section snippets
Case report
A 66-yr-old male presented initially with gross painless hematuria in January 2008. Cystoscopic evaluation revealed an erythematous area of the bladder, and subsequent directed and random biopsies demonstrated focal urothelial carcinoma in situ (CIS) with no invasion into the lamina propria. Muscularis propria was present in the specimen and was not involved. The patient underwent six weekly installations of intravesical bacillus Calmette-Guérin (BCG) therapy uneventfully from May 2008 to June
Discussion
The standard treatment options for CIS of the bladder are intravesical BCG immunotherapy or immediate cystectomy for selected patients. Complications of BCG immunotherapy include cystitis (up to 90%), fever (3%), and hematuria (up to 34%) [1], [2]. Symptoms of cystitis, including frequency, dysuria, hematuria, and low-grade fevers, usually occur after the third dose and are usually managed with supportive therapy. Local granulomatous infections can include granulomatous prostatitis (clinically
Conflicts of interest
The authors have nothing to disclose.
EU-ACME question
Please visit www.eu-acme.org/europeanurology to answer the following EU-ACME question online (the EU-ACME credits will be attributed automatically).
Question:
Intravesical bacillus Calmette-Guérin (BCG) is absolutely contraindicated for all of the following patients except:
- A.
The patient who is on immunosuppressive medication.
- B.
The patient who has a traumatic catheterization and develops hematuria prior to instillation.
- C.
The patient with a history of BCG sepsis.
- D.
The patient with a history of tuberculosis.
References (10)
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Complications of intravesical therapy for urothelial cancer of the bladder
J Urol
(2006) Complications of bacillus Calmette-Guérin immunotherapy
Urol Clin North Am
(1992)- et al.
Late Mycobacterium bovis spondylitis after intravesical BCG therapy
Joint Bone Spine
(2009) - et al.
Mycobacterium bovis vertebral osteomyelitis as a complication of intravesical BCG use
Mayo Clin Proc
(2002)
Cited by (14)
Osteomyelitis and septic arthritis after Mycobacterium Bovis BCG Therapy for Urinary Bladder Cancer
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Tuberculous spondylitis following intravesical bcg-instillation in the treatment of transitional cell carcinoma: Case report and systematic review
2020, Clinical Neurology and NeurosurgeryCitation Excerpt :Vesicular epithelial trauma following BCG-instillation forms the major risk factor in developing PD. These risks factors include transurethral prostate resection, bladder biopsy within two weeks after instillation, catheterization of bladder epithelium, urethral injury, bladder outlet obstruction, pelvic radiation, obstructive uropathy, severe cystitis, recent spinal trauma, an immunocompromised state and advanced age [5,7–9,17,19]. A normal bladder mucosa prevents transvesical spread of infection [9,14].
A thoracic tuberculous spondylodisctis after intravesical BCG immunotherapy of bladder cancer – Case report and literature review
2015, Neurologia i Neurochirurgia PolskaBCG-induced discitis and osteomyelitis in a patient with a history of bladder cancer
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