SHM Converge Scientific Abstract ePoster Gallery-Mycobacterium Bovis Discitis-Osteomyelitis With Associated Epidural Abscess Complicating BCG Immunotherapy

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This case report describes an 86-year-old man who developed rare musculoskeletal complications after intravesical BCG immunotherapy for bladder cancer. Twelve months after treatment, he presented with three months of worsening back pain and weight loss, without fever, cough, or urinary symptoms. Examination showed limited lumbar range of motion but no focal neurologic deficits. Laboratory tests were notable for elevated ESR, and MRI revealed T12-L1 discitis-osteomyelitis, an anterior epidural abscess at L1, and a right psoas abscess. Biopsy of the psoas abscess identified <em>Mycobacterium bovis</em>, consistent with disseminated BCG infection. Sputum cultures were negative for acid-fast bacilli.

He was treated with rifampin, isoniazid, and ethambutol and discharged to sub-acute rehabilitation.

The report emphasizes that although BCG is a live attenuated strain of <em>M. bovis</em> and is generally safe, infectious complications occur in fewer than 5% of patients. Disseminated musculoskeletal infection is rare but can include osteomyelitis, spondylitis, epidural abscess, and psoas abscess. Risk factors include advanced age, immunosuppression, traumatic catheterization, acute cystitis, and persistent hematuria after transurethral surgery.

The authors conclude that clinicians should consider <em>M. bovis</em> infection in patients with compatible infectious or inflammatory symptoms after prior BCG therapy. MRI is highlighted as the best imaging modality for detecting spinal and soft tissue abscesses, while mycobacterial culture with PCR confirmation remains the diagnostic gold standard. Standard treatment is prolonged therapy with rifampin, isoniazid, and ethambutol for about 9–12 months.

Asset Subtitle

Sabrina Bulancea

Meta Tag

Author List Aanchal Tyagi, Benjamin Ossai, Jonathan London, Jorgio Auguste, Muhammad Israr Ul Haq, Olena Bolotova, Sabrina Bulancea, Zubin Tharayil

Category Clinical Vignettes

Concept Intravesical Bacillus Calmette-Guérin therapy

Concept Mycobacterium bovis

Concept Disseminated infection

Concept Discitis-osteomyelitis

Concept Epidural Abscess

Distinguished Non-Finalist

Presenter Organization Long Island Community Hospital

Presenting Author Sabrina Bulancea

Track Adult

Keywords

intravesical BCG

Mycobacterium bovis

bladder cancer

discitis-osteomyelitis

epidural abscess

psoas abscess

MRI

mycobacterial culture

rifampin isoniazid ethambutol

disseminated infection

Intravesical Bacillus Calmette-Guérin therapy

Mycobacterium bovis

Disseminated infection

Discitis-osteomyelitis

Epidural Abscess