Yergin Celeste G, Pafford Ryan, Pirris John, Rao Dinesh, Rahmathulla Gazanfar
Neurological Surgery, University of Florida College of Medicine, Jacksonville, USA.
Cardiothoracic Surgery, University of Florida College of Medicine, Jacksonville, USA.
Cureus. 2021 Aug 25;13(8):e17446. doi: 10.7759/cureus.17446. eCollection 2021 Aug.
Intravesical administration of bacille Calmette-Guérin (BCG) is an important component of the gold standard in treating non-muscle invasive bladder cancer (NMIBC). However, complications of this treatment include infections caused by the dissemination of . We present a case of a 62-year-old man who had been treated with intravesical BCG for bladder cancer and developed an infection of his vertebral column. About four months after completing the BCG treatment, he developed an acute onset of severe upper thoracic radicular back pain, with radiation anteriorly to his sternum. Examination revealed the presence of early myelopathy. After other causes were ruled out, he was diagnosed with the infection four months later. He was investigated for the pain, with resulting imaging identifying an erosive ventral epidural mass at the T4-T5 levels causing cord compression. The patient underwent a transthoracic procedure to evacuate the paraspinal mass lesion and obtain a diagnostic biopsy, followed by a posterolateral decompression of the lesion and posterior instrumented stabilization. Pathology resulted in the identification of a granuloma with a single acid-fast bacillus (AFB) from the paraspinal abscess, thus being diagnostic of a mycobacterial granuloma with paraspinal involvement. We subsequently performed an extensive review of current literature, looking at articles on spinal osteomyelitis following intravesical BCG treatment of bladder cancer. We identified 26 documented cases in English literature. We present our case report with a good outcome at 24 months, resolving with appropriate chemotherapy. Additionally, we completed a systematic review of the literature and discuss this infrequent iatrogenic pathology. Our report reveals the good response to targeted therapy in the case of osteomyelitis at other skeletal sites and that practitioners caring for these patients maintain a high degree of suspicion in the workup of these patients. Early identification and treatment can appropriately treat osteomyelitis with good long-term outcomes.
膀胱内灌注卡介苗（BCG）是治疗非肌层浸润性膀胱癌（NMIBC）金标准的重要组成部分。然而，这种治疗的并发症包括因卡介苗播散引起的感染。我们报告一例62岁男性，他接受了膀胱内卡介苗治疗膀胱癌，随后发生了脊柱感染。在完成卡介苗治疗约四个月后，他突然出现严重的上胸部神经根性背痛，并向前放射至胸骨。检查发现早期脊髓病。排除其他病因后，四个月后他被诊断为感染。针对疼痛进行检查，影像学检查发现T4-T5水平有侵蚀性腹侧硬膜外肿块，导致脊髓受压。患者接受了经胸手术，以清除椎旁肿块病变并进行诊断性活检，随后对病变进行后外侧减压和后路器械固定。病理检查从椎旁脓肿中发现了一个含有单个抗酸杆菌（AFB）的肉芽肿，从而诊断为累及椎旁的分枝杆菌肉芽肿。我们随后对当前文献进行了广泛回顾，查阅了关于膀胱内卡介苗治疗膀胱癌后脊柱骨髓炎的文章。我们在英文文献中确定了26例记录在案的病例。我们报告了该病例，患者在24个月时取得了良好的结果，通过适当的化疗得以康复。此外，我们完成了文献的系统综述，并讨论了这种罕见的医源性病理情况。我们的报告显示，在其他骨骼部位发生骨髓炎的情况下，靶向治疗有良好反应，并且照顾这些患者的医生在对这些患者的检查中保持高度怀疑。早期识别和治疗可以恰当地治疗骨髓炎，并取得良好的长期效果。
