Archive for July 1, 2017

Mycobacterial Osteomyelitis of the Spine Following Intravesical BCG Therapy for Bladder Cancer.

Cureus. 2016 Mar 26;8(3):e545.                                                 

Mackel CE1, Burke SM1, Huhta T1, Riesenburger R1, Weller SJ1.

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1 Department of Neurosurgery, Tufts University School of Medicine/Tufts Medical Center.


Osteomyelitis is an infection of the bone that can involve the vertebral column.

A rare cause of vertebral osteomyelitis is Mycobacterium bovis after intravesical Bacillus Calmette-Guerin (BCG) therapy for transitional cell carcinoma of the bladder.

In this report, we describe the case of a 64-year-old male presenting with constitutional symptoms, progressive thoracic kyphosis, and intractable T11 and T12 radiculopathies over the proceeding six months. A CT scan revealed erosive, lytic changes of the T12 and L1 vertebrae with compression of the T12 vertebra.

An MRI demonstrated T11-12 osteomyelitis with intervening discitis and extensive paraspinal enhancement with a corresponding hyperintensity on a short tau inversion recovery (STIR) sequence.

A needle aspiration grew out Mycobacterial tuberculosis complex that was pansensitive to all antimicrobial agent therapies, except pyrazinamide on culture, a finding consistent with an M. bovis infection.

The patient’s infection and neurologic compromise resolved after transthoracic T11-12 vertebrectomies with decompression of the spinal cord and nerve roots as well as T10-L1 instrumented fusion and protracted antimicrobial therapy.

The epidemiology and natural history of M. bovis osteomyelitis are reviewed and the authors emphasize a mechanism of vertebral inoculation to explain the predilection of M. bovis osteomyelitis in males after intravesical BCG therapy



July 1, 2017 at 4:28 pm

Mycobacterium bovis Osteomyelitis of the Thoracic Spine Mimicking a Metastatic Lytic Lesion in a Patient Exposed to Intravesicular Bacille Calmette-Guérin Treatment.

Urol Case Rep. 2014 Jul 2;2(4):142-4.                                

Newman JR1, Clough LA1, Merino F1.

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1 Division of Infectious Diseases, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.


An 80-year-old man with previous intravesicular bacille Calmette-Guérin therapy developed mass lesions of the lower thoracic spine. Metastatic disease was suspected.

The patient underwent a course of radiation; however, biopsy later demonstrated fibrosis and cultures grew Mycobacterium bovis.

The patient was treated with a course of isoniazid, rifampin, and ethambutol.


July 1, 2017 at 4:26 pm

Vertebral Osteomyelitis: Clinical Features and Diagnosis

Clinical Microbiology and Infection April 2014

Şebnem Eren Gök1, Erkan Kaptanoğlu2, Aysel Çelikbaş1, Önder Ergönül3,*, Nurcan Baykam1, Mustafa Eroğlu1 andBaşak Dokuzoğuz1


We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment.


This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed from six months to three years.


In total 214 patients were included to the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) were brucella vertebral osteomyelitis (BVO), 63 (29%) were tuberculous vertebral osteomyelitis (TVO), and 55 (26%) were pyogenic vertebral osteomyelitis (PVO). Mean days between onset of symptoms and establishment of diagnosis were longer with the patients TVO (266 days) than BVO (115 days) or PVO (151 days) (p<0.001). In blood cultures, Brucella spp was isolated among 35 out of 96 BVO patients (35%). Among 55 PVO patients, etiologic agent was isolated in 11 (20%) patients. For tuberculin skin test (TST) >15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and ROC area was 0.8.


Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of VO, consumption of fresh cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, lumbar involvement in MRI were found to be predictors of BVO, thoracic involvement in MRI and TST> 15 mm were found to be predictors of TVO, and history of spinal surgery and leukocytosis were found to be predictors of PVO.



July 1, 2017 at 4:10 pm


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