Combined infection of vertebroplasty and aortic graft after intravesical BCG treatment

Abstract

We report a 58-year-old man with spondylodiscitis by Mycobacterium bovis-BCG 3 years after intravesical BCG treatment, and shortly after a vertebroplasty. Further examination showed a psoas abscess and oedema around an endovascular aortic graft, which had been placed 1 year earlier. Puncture of the psoas abscess also grew M bovis-BCG. The patient recovered with a combination of antituberculous treatment and surgery. With hindsight a mycotic aneurysm had been present at the time of aortic graft placement and spondylodiscitis at the time of vertebroplasty. This case shows that low grade and longstanding infections may occur following intravesical BCG installation.

Miliary tuberculosis in a patient with tuberculous mycotic aneurysm of the abdominal aorta: Case report and review of the literature

“…Other reasons that suggest a possible imminent increase is the emergence of infections by atypical mycobacteria and intravesical BCG injections for bladder cancer. Mycotic aneurysm of the aorta arising from M. intracellulare has been already reported [34], while in a recent review of the literature 2 of the 28 cases were due to BCG [8], [12].…”

“…A review of the English literature from 2008 to today revealed 28 more cases (Table 1) [3], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], specifically 18 men and 10 women with a mean age of 44.64 ± 18.16 years (range 16–84). 7 patients had a history of pulmonary tuberculosis and had previously received anti-tuberculosis medication.…”

Tuberculous Spondylitis Caused by Intravesical Bacillus Calmette-Guerin Therapy

“…Intravesical BCG therapy for the treatment of superficial bladder cancer has a low risk of extravesical complications, which are rare (5), but adverse effects such as cystitis, a fever, hematuria, prostatitis, arthralgias, and reactive arthritis are relatively common. The first study to mention tuberculous spondylitis caused by intravesical BCG therapy was reported in 1992, but only 13 cases related to intravesical BCG therapy for bladder cancer have been reported since (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) (Table). In most cases, BCG spondylitis develops several months after intravesical BCG therapy, while some cases may develop several years later, but the cause is unknown (13).…”

“…The first study to mention tuberculous spondylitis caused by intravesical BCG therapy was reported in 1992, but only 13 cases related to intravesical BCG therapy for bladder cancer have been reported since (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) (Table). In most cases, BCG spondylitis develops several months after intravesical BCG therapy, while some cases may develop several years later, but the cause is unknown (13). It is important to confirm the history of intravesical BCG for the differential diagnosis because M. bovis BCG may spread hematogenously to distant sites over the course of months or years and develop into M. bovis BCG infection.…”

Rare case of a proximal descending thoracic aorta mycotic aneurysm following intravesical BCG injections for the treatment of bladder cancer

“…A very rare, and sometimes fatal, consequence of systemic BCG infection (BCG-osis) is the formation of peripheral and aortic aneurysms. Only four reported cases have undergone endovascular repair, 2 thoracic endovascular aneurysm repairs (TEVARs) for distal descending thoracic aneuryms and 2 endovascular aortic aneurysm repairs (EVARs) for infrarenal aneurysms 4–7. We describe the first reported endovascular repair of an incidentally found proximal descending aortic aneurysm 15 months following systemic BCG-osis secondary to intravesical BCG therapy.…”