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[Chronic reactive arthritis associated with Calmette-Guérin bacillus]
C Neumayr1, A Kirchgatterer, P Knoflach
1Allgemeines öffentliches Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz, I. Interne Abteilung mit Gastroenterologie und Hepatologie, Diabetologie und Rheumatologie, Wels, Osterreich, Germany. neumayr@christine@utanet.at
History And Admission Findings:
After successful transurethral resection of a superficial bladder cancer a 59-year old patient was treated with intravesical instillation of bacillus Calmette-Guérin (BCG) six times to prevent tumor recurrence. Four weeks later the patient was admitted to our department presenting with symmetrical polyarthritis accompanied by pain and stiffness and conjunctivitis.
Investigations:
Laboratory tests showed evidence of severe inflammation, but 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.
Diagnosis:
In this patient, the history, admission findings and laboratory tests led to the diagnosis of BCG-immunotherapy associated reactive arthritis.
Treatment And Course:
Nonsteroidal antiinflammatory therapy was ineffective but glucocorticoid therapy resulted in a partial response. With additional administration of the antituberculosis agent isoniazid for 3 months, all symptoms resolved.
Conclusion:
Reactive arthritis can be induced by BCG-immunotherapy. The treatment with nonsteroidal antiinflammatory drugs and steroids is sufficient in many patients. In case of unresponsiveness, however, antituberculosis therapy is indicated.