Refractory arthropathy after intravesical bacillus Calmette-Guérin therapy. Usefulness of isoniazide

Arthritis associated with bacillus Calmette-Guérin immunotherapy usually responds dramatically to nonsteroidal antiinflammatory drug therapy. Isoniazid is generally reserved for other complications such as granulomatous hepatitis.

A 73-year-old man was admitted for fever, arthritis of the knees and right temporomandibular joint, an inflammatory swelling over the left Achilles tendon and bilateral conjunctivitis. The symptoms started in the wake of a course of intravesical bacillus Calmette-Guérin immunotherapy. Laboratory tests showed evidence of severe inflammation. Cultures of blood, urine and joint fluid specimens were negative, as were tests for autoantibodies and serologic tests for organisms known to cause reactive arthritis. Nonsteroidal antiinflammatory therapy was ineffective and glucocorticoid therapy produced only a partial response. All the symptoms resolved under isoniazid therapy in a dosage of 300 mg/day for three months.

Use of antituberculous agents may be required in some cases of arthritis associated with bacillus Calmette-Guérin immunotherapy, most notably those with severe pyrexia.