Miyazaki Masashi, Yoshiiwa Toyomi, Ishihara Toshinobu, Kawano Masanori, Tsumura Hiroshi
Department of Orthopaedic Surgery, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan.
Case Rep Orthop. 2016;2016:6741284. doi: 10.1155/2016/6741284. Epub 2016 May 30.
We present a rare case of tuberculous spondylitis following intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. An 82-year-old man presented with low back pain. Past medical history revealed bladder cancer diagnosed and treated 16 months previously by intravesical BCG. Magnetic resonance imaging of the thoracic spine showed destruction of the T5 and T6 vertebrae and an epidural soft tissue mass with anterior dural sac compression. Due to the progression of vertebral destruction, posterior spinal segmental fusion was performed. Mycobacterium bovis (M. bovis) was identified using multiplex polymerase chain reaction of surgical tissue specimens. The patient was started on an antituberculosis treatment regimen including isoniazid, rifampicin, and ethambutol. After surgery, his back pain resolved completely. At the latest examination, the patient was pain-free with no functional limitations or recurrent infection in clinical or imaging findings. Patients undergoing BCG therapy should be monitored for possible hematogenous spread of mycobacteria to the spine for months or even years after treatment.
我们报告了一例膀胱癌患者在膀胱内灌注卡介苗（BCG）治疗后发生结核性脊柱炎的罕见病例。一名82岁男性因腰痛就诊。既往病史显示，16个月前曾诊断为膀胱癌并接受膀胱内BCG治疗。胸椎磁共振成像显示T5和T6椎体破坏，硬膜外软组织肿块伴硬膜囊前受压。由于椎体破坏进展，进行了后路脊柱节段融合术。通过手术组织标本的多重聚合酶链反应鉴定出牛分枝杆菌（M. bovis）。患者开始接受包括异烟肼、利福平及乙胺丁醇的抗结核治疗方案。术后，他的背痛完全缓解。在最近一次检查时，患者没有疼痛，临床及影像学检查未发现功能受限或反复感染。接受BCG治疗的患者在治疗后数月甚至数年都应监测是否可能发生分枝杆菌血行播散至脊柱。
