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Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication: review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases

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Abstract

Mycobacterium bovis Bacillus Calmette-Guérin (BCG) instillations are used in bladder cancer treatment. Adverse effects can occur. Osteoarticular complications are mainly reactive arthritis, but true infections have been described, such as vertebral osteomyelitis. We made a review of M. bovis BCG vertebral osteomyelitis after instillations for bladder cancer using PubMed search. We added three new French cases. Twenty-seven cases of BCG vertebral osteomyelitis had been reported on PubMed. Of the 30 cases, all were male, averaging 73.4 ± 8.7 years old. Median time between diagnosis and first and last instillation was 22.5 and 14 months respectively. Half of vertebral osteomyelitis was thoracic and lumbar in the other half. Sensitivo-motor deficit was present at diagnosis in 42% of cases. Other infectious locations were common, mainly infectious abdominal aortic aneurysms (20%). Rifampicin, ethambutol and isoniazid were the usual therapy. Poor outcomes were reported with 50% of one or more spine surgery. M. bovis BCG vertebral osteomyelitis following bladder instillation for bladder cancer is a rare complication. However, the late onset of back pain after instillations differentiates them from reactive arthritis. Concomitant septic location such as infectious abdominal aortic aneurysms must be known.

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Authors and Affiliations

  1. Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France

    Simon Cadiou

  2. Department of Rheumatology, Centre Hospitalier René Dubos, 95301, Pontoise, France

    Omar Al Tabaa & Edouard Pertuiset

  3. Department of Rheumatology, Hôpital St Philibert GHICL, 249 Rue du grand but, 59462, Lomme, France

    Chi-Duc Nguyen & Eric Houvenagel

  4. Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France

    Marine Faccin, Pascal Guggenbuhl & Guillaume Coiffier

  5. Department of Medical Imaging, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France

    Raphaël Guillin

  6. Infectious Diseases and Intensive Care Unit, CHU Univ Rennes, Inserm U 1230, F-35000, Rennes, France

    Matthieu Revest

  7. CHU Rennes, Univ Rennes, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000, Rennes, France

    Pascal Guggenbuhl

  8. UMR INSERM U 1241, University of Rennes 1, 35000, Rennes, France

    Pascal Guggenbuhl & Guillaume Coiffier

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  1. Simon Cadiou
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Cadiou, S., Al Tabaa, O., Nguyen, CD. et al. Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication: review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases. Clin Rheumatol 38, 1773–1783 (2019). https://doi.org/10.1007/s10067-019-04500-w

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