SHM Converge Scientific Abstract ePoster Gallery-Battling Bones: Diagnostic Odyssey of Mycobacterium Osteomyelitis After Intravesical BCG

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A 70-year-old man with a history of bladder cancer treated with intravesical Bacillus Calmette-Guérin (BCG) presented with worsening acute-on-chronic back pain after months of treatment for presumed culture-negative bacterial osteomyelitis. He had previously undergone L3-L5 laminectomy and a 6-week empiric antibiotic course, but his pain and mobility continued to decline over six months. On readmission, he had stable vital signs, marked lumbar tenderness, elevated inflammatory markers, and MRI evidence of progression of vertebral osteomyelitis. He was initially restarted on broad-spectrum antibiotics and admitted.<br /><br />Because the disease was refractory to standard therapy, clinicians broadened the differential diagnosis. Given his prior intravesical BCG exposure and imaging suggestive of Pott’s disease, mycobacterial infection was suspected. He underwent surgical debridement, and tissue cultures were sent. He was started empirically on rifampin, isoniazid, ethambutol, and pyridoxine. Surgical cultures later grew mycobacterium, confirming tuberculous vertebral osteomyelitis.<br /><br />The patient improved with antituberculous therapy, with gradual recovery in pain and ambulation on outpatient follow-up. The case highlights a rare but serious complication of intravesical BCG therapy and emphasizes the importance of avoiding cognitive biases such as anchoring, diagnostic momentum, and premature closure when evaluating persistent osteomyelitis that does not respond to conventional antibiotics.

Asset Subtitle

Vatsal Y. Bhatt

Meta Tag

Author List Christian Wood, Vatsal Y. Bhatt

Category Clinical Vignettes

Concept Vertebral osteomyelitis

Concept Mycobacterial Osteomyelitis

Concept Intravesical Bacillus Calmette-Guérin therapy

Concept Surgical Tissue Culture

Concept Mycobacterial Testing

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Vatsal Y. Bhatt

Track Adult

Keywords

intravesical BCG

vertebral osteomyelitis

tuberculous osteomyelitis

Pott’s disease

bladder cancer

mycobacterial infection

culture-negative osteomyelitis

rifampin isoniazid ethambutol

diagnostic bias

surgical debridement

Vertebral osteomyelitis

Mycobacterial Osteomyelitis

Intravesical Bacillus Calmette-Guérin therapy

Surgical Tissue Culture

Mycobacterial Testing