Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France.
Department of Rheumatology, Centre Hospitalier René Dubos, 95301, Pontoise, France.
Clin Rheumatol. 2019 Jun;38(6):1773-1783. doi: 10.1007/s10067-019-04500-w. Epub 2019 Mar 13.
Mycobacterium bovis Bacillus Calmette-Guérin (BCG) instillations are used in bladder cancer treatment. Adverse effects can occur. Osteoarticular complications are mainly reactive arthritis, but true infections have been described, such as vertebral osteomyelitis. We made a review of M. bovis BCG vertebral osteomyelitis after instillations for bladder cancer using PubMed search. We added three new French cases. Twenty-seven cases of BCG vertebral osteomyelitis had been reported on PubMed. Of the 30 cases, all were male, averaging 73.4 ± 8.7 years old. Median time between diagnosis and first and last instillation was 22.5 and 14 months respectively. Half of vertebral osteomyelitis was thoracic and lumbar in the other half. Sensitivo-motor deficit was present at diagnosis in 42% of cases. Other infectious locations were common, mainly infectious abdominal aortic aneurysms (20%). Rifampicin, ethambutol and isoniazid were the usual therapy. Poor outcomes were reported with 50% of one or more spine surgery. M. bovis BCG vertebral osteomyelitis following bladder instillation for bladder cancer is a rare complication. However, the late onset of back pain after instillations differentiates them from reactive arthritis. Concomitant septic location such as infectious abdominal aortic aneurysms must be known.
牛分枝杆菌卡介苗（BCG）膀胱灌注用于膀胱癌的治疗。可能会出现不良反应。骨关节并发症主要是反应性关节炎，但也有真性感染的报道，如脊椎骨髓炎。我们使用 PubMed 搜索对膀胱癌灌注后牛分枝杆菌卡介苗引起的脊椎骨髓炎进行了综述。我们增加了三个法国新病例。在 PubMed 上共报道了 27 例 BCG 脊椎骨髓炎。30 例患者均为男性，平均年龄 73.4±8.7 岁。诊断与首次和末次灌注之间的中位时间分别为 22.5 个月和 14 个月。一半的脊椎骨髓炎位于胸腰椎，另一半位于其他部位。42%的病例在诊断时存在感觉运动障碍。其他常见的感染部位主要是感染性腹主动脉瘤（20%）。利福平、乙胺丁醇和异烟肼是常用的治疗方法。报道称有 50%的患者需要进行一次或多次脊柱手术，预后不良。膀胱癌膀胱灌注后牛分枝杆菌卡介苗引起的脊椎骨髓炎是一种罕见的并发症。然而，与反应性关节炎不同的是，灌注后出现的腰痛发病较晚。必须了解同时存在的感染部位，如感染性腹主动脉瘤。
