Seegobin Karan, Maharaj Satish, Baldeo Cherisse, Isache Carmen, Gharia Bharatsinh, Zuberi Lara
Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.
Department of Infectious Disease, University of Florida College of Medicine, Jacksonville, FL, USA.
IDCases. 2017 Sep 28;10:75-78. doi: 10.1016/j.idcr.2017.09.008. eCollection 2017.
Mycobacteria Bovis osteomyelitis is a rare adverse effect after Bacillus Calmette-Guerin (BCG) intravesical therapy. A 62-year-old male presented with acute spinal cord compression three months after completing his second course of therapy for bladder cancer. The first course with intravesical BCG was complicated with an episode of hematuria. He reported intermittent subjective fever for 3 weeks thereafter which resolved with Tylenol. Interferon-α2 B was added to the second cycle of intravesical BCG with the indication here being residual tumor, and was tolerated well. His complete blood count and liver function tests were unremarkable on admission. MRI showed features of osteomyelitis with cord compression at T4/T5. Biopsy of the affected bone showed caseating granuloma which was positive for acid fact bacilli, later confirmed to be Mycobacterium Bovis by PCR and pyrazinamide resistance. He was started on intravenous steroids and underwent spinal cord decompression. Rifampin, Isoniazid, and Ethambutol were then commenced. His weakness improved and after two months of therapy he was asymptomatic and back to his baseline function. Osteomyelitis is a rare but serious complication. Early diagnosis and treatment is important as the outcomes are good.
牛分枝杆菌骨髓炎是卡介苗（BCG）膀胱内灌注治疗后一种罕见的不良反应。一名62岁男性在完成膀胱癌第二疗程治疗三个月后出现急性脊髓压迫。首次膀胱内灌注卡介苗治疗时出现了一次血尿并发症。此后他自述间歇性发热3周，服用泰诺后症状缓解。在卡介苗膀胱内灌注的第二个周期中加用了α2B干扰素，指征为残留肿瘤，且耐受性良好。入院时他的全血细胞计数和肝功能检查均无异常。MRI显示T4/T5水平存在骨髓炎伴脊髓压迫的表现。对受累骨骼进行活检显示干酪样肉芽肿，抗酸杆菌染色阳性，后经PCR和吡嗪酰胺耐药试验确诊为牛分枝杆菌。他开始接受静脉类固醇治疗并接受了脊髓减压手术。随后开始使用利福平、异烟肼和乙胺丁醇治疗。他的虚弱症状有所改善，经过两个月的治疗，他无症状，恢复到了基线功能。骨髓炎是一种罕见但严重的并发症。由于预后良好，早期诊断和治疗很重要。
