Journal of Medical Ultrasonics

, Volume 46, Issue 1, pp 163–165 | Cite as

Ultrasonographic findings in a patient with reactive arthritis induced by intravesical BCG therapy for bladder cancer

  • Hitoshi Yoshimura
  • Tadashi OkanoEmail author
  • Kentaro Inui
  • Hiroaki Nakamura
Case Report


Intravesical bacillus Calmette–Guerin (BCG) therapy is an effective and safe immunotherapy for superficial bladder cancer. However, reactive arthritis (ReA) is reported as an adverse event in about 0.5–1% of patients receiving intravesical BCG therapy. ReA is known as a kind of spondyloarthritis, the main pathological finding of which is enthesitis. Here we report a patient with ReA induced by intravesical BCG therapy for bladder cancer, in whom the diagnosis of ReA was supported by ultrasonographic findings of enthesitis and synovitis. A 69-year-old male was diagnosed with carcinoma in situ of the bladder and treated with intravesical BCG therapy. After the third intravesical BCG injection, pain and swelling appeared in both wrists. Ultrasonographic examination revealed not only intra-articular synovitis in the bilateral wrist joint, wrist flexor tenosynovitis, and wrist extensor tenosynovitis, but also enthesitis of the flexor carpi radialis tendon (FCR). The severe enthesitis of the FCR in both wrists was considered to be an important finding that supported the diagnosis in this patient. Thus, we diagnosed this case as ReA induced by intravesical BCG therapy. In clinical practice, ReA is often difficult to distinguish from seronegative rheumatoid arthritis and other rheumatic diseases. Ultrasonographic findings of enthesitis may support a definitive diagnosis for these patients.


Ultrasonography Enthesitis Reactive arthritis Spondyloarthritis BCG therapy 



No specific funding was received to carry out the work described in this manuscript.

Compliance with ethical standards

Conflict of interest

The authors have declared no conflicts of interest.

Ethical statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from the patient for being included in the study.


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Copyright information

© The Japan Society of Ultrasonics in Medicine 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryOsaka City University Graduate School of MedicineOsakaJapan

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