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[BCG osteoarthritis on knee prosthesis after intra-vesical BCG therapy]
P Chazerain1, N Desplaces, J M Ziza
1Service de Médecine Interne et Rhumatologie, Hôpital de la Croix Saint-Simon, Paris.
Insights
A knee implant infection caused by Calmette-Guérin bacillus (BCG) during therapy resolved favorably after surgery and antitubercular treatment. This septic osteoarthritis case, likely from bloodstream BCG diffusion, differs from reactive polyarthritis.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Immunology
Background:
- Intravesical Bacillus Calmette-Guérin (BCG) therapy is a standard treatment for superficial bladder cancer.
- BCG instillation can rarely lead to disseminated infections or reactive inflammatory conditions.
- Prosthetic joint infections are serious complications requiring prompt diagnosis and management.
Observation:
- A patient undergoing intravesical BCG therapy developed a knee implant infection.
- The infection presented as septic osteoarthritis, distinct from reactive polyarthritis.
- The likely source of infection was hematogenous dissemination of BCG.
Findings:
- Surgical replacement of the infected knee implant was performed.
- Antitubercular agents were administered to treat the BCG infection.
- The patient experienced a favorable clinical outcome following treatment.
Implications:
- This case highlights the potential for hematogenous spread of BCG to orthopedic implants during therapy.
- Early recognition and aggressive management, including implant revision and antimicrobial therapy, are crucial for favorable outcomes.
- Distinguishing BCG-induced septic arthritis from reactive polyarthritis is important for appropriate treatment strategies.
Abstract:
A case of Calmette-Guérin bacillus (BCG) infection of a knee implant during intravesical BCG-therapy is reported. The course was favorable after replacement of the implant and administration of antituberculous agents. This case of septic osteoarthritis due to the BCG is different from cases of reactive polyarthritis reported after intravesical instillations of BCG. It probably resulted from diffusion of the BCG via the bloodstream.