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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 21, Issue 1, Pages e75-e78
http://dx.doi.org/10.1155/2010/572410
Case Report

A Case of Pott’s Disease with Epidural Abscess and Probable Cerebral Tuberculoma following Bacillus Calmette-Guérin Therapy for Superficial Bladder Cancer

Colin B Josephson,1 Saleh Al-Azri,2 Daniel J Smyth,3 David Haase,2 and B Lynn Johnston2

1Divisions of Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
2Infectious Disease, Dalhousie University, Halifax, Nova Scotia, Canada
3Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is an accepted treatment for transitional cell carcinoma of the bladder. Carcinoma in situ of the bladder progresses to invasive muscular disease in approximately 54% of untreated patients, mandating early initiation of therapy once the diagnosis is confirmed. Should BCG treatment fail, an additional course of BCG combined with interferon-alpha, both administered intravesically, is a promising second-line immunotherapy. In greater than 95% of patients, BCG is tolerated without significant morbidity or mortality. However, both early (within three months of the original treatment) and late presentations of systemic infection resulting from intravesical BCG treatment have been described. The present study describes the course of a 75-year-old man with a late presentation of BCG vertebral osteomyelitis, discitis, epidural abscess, bilateral psoas abscesses and probable cerebral tuberculoma, following treatment regimens of intravesical BCG followed by intravesical BCG plus interferon-alpha 2b.