Case of the Month – September 2019
By Dr Michael Curley
A 64 year old male presented with new back pain, anorexia and weight loss. This was 9 months after receiving Bacillus Calmette-Guerin (BCG) Immunotherapy for high-grade transitional cell carcinoma of the bladder.
A FDG PET/CT was performed, which demonstrated osteolysis and intense FDG avidity of the T6/T7 and T8/T9 vertebral endplates. In addition, an aneurysm with FDG-avid soft tissue was present of the distal left common iliac artery. The provisional diagnosis was disseminated BCG infection resulting in spondylodiscitis and a mycotic aneurysm.
A CT-guided vertebral biopsy confirmed the presence of Mycobacterium tuberculosis DNA on polymerase chain reaction testing.
Disseminated BCG infection following BCG immunotherapy for TCC of the bladder. (BCGosis)