Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Orthopedics
Volume 2016 (2016), Article ID 6741284, 4 pages
http://dx.doi.org/10.1155/2016/6741284
Case Report

Tuberculous Spondylitis following Intravesical Bacillus Calmette-Guerin for Bladder Cancer

Department of Orthopaedic Surgery, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan

Received 4 February 2016; Accepted 9 May 2016

Academic Editor: Hitesh N. Modi

Copyright © 2016 Masashi Miyazaki et al. 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

We present a rare case of tuberculous spondylitis following intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. An 82-year-old man presented with low back pain. Past medical history revealed bladder cancer diagnosed and treated 16 months previously by intravesical BCG. Magnetic resonance imaging of the thoracic spine showed destruction of the T5 and T6 vertebrae and an epidural soft tissue mass with anterior dural sac compression. Due to the progression of vertebral destruction, posterior spinal segmental fusion was performed. Mycobacterium bovis (M. bovis) was identified using multiplex polymerase chain reaction of surgical tissue specimens. The patient was started on an antituberculosis treatment regimen including isoniazid, rifampicin, and ethambutol. After surgery, his back pain resolved completely. At the latest examination, the patient was pain-free with no functional limitations or recurrent infection in clinical or imaging findings. Patients undergoing BCG therapy should be monitored for possible hematogenous spread of mycobacteria to the spine for months or even years after treatment.