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Rare disease
Case report
Prosthetic joint infection: an extremely rare complication of intravesicular BCG therapy
  1. Michael Storandt1 and
  2. Avish Nagpal1,2
  1. 1 School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
  2. 2 Infectious Diseases, Sanford Health, Fargo, North Dakota, USA
  1. Correspondence to Dr Avish Nagpal; avishnagpal{at}gmail.com

Abstract

A 66-year-old man was seen in clinic due to concerns of tuberculosis of the right hip. He had a history of urothelial bladder carcinoma, which was treated via transurethral resection followed by intravesicular instillations of Mycobacterium bovis BCG (BCG). A few months later, he developed slowly worsening pain over his prosthetic right hip, and it was recommended he undergo surgical revision. During surgery, joint effusion was noted and synovial fluid was sent for bacterial and mycobacterial cultures, growing an acid-fast bacillus after 3 weeks, identified as Mycobacterium tuberculosis complex via nucleic acid probe. Susceptibility testing revealed resistance to pyrazinamide, which is typically seen in M. bovis. PCR confirmed the diagnosis of BCG infection. The patient was treated with isoniazid, rifampin and ethambutol, which he tolerated well. This case highlights the challenges associated with diagnosis and management of this rare complication of a commonly used therapy.

  • hip implants
  • prosthesis failure
  • infectious diseases
  • bone and joint infections

https://doi.org/10.1136/bcr-2019-232809

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    Footnotes

    • Contributors AN is an Infectious Disease specialist who was consulted for treatment of this patient with BCG prosthetic joint infection. AN recognised the rarity of this complication, so when contacted by MS, a medical student at the University of North Dakota who was interested in working on composing a case study, AN recognised this would be a valuable case to publish. AN provided the case narrative and MS reviewed current literature surrounding this rare condition. MS composed the first draft of the case report in addition to the table included within the manuscript, which AN revised and made additions to. They worked jointly in recognising important conclusions and discussion points to make note of in the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.