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Case of the Month – September 2019

By Dr Michael Curley

History:

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.

Imaging:

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.

Findings:

A CT-guided vertebral biopsy confirmed the presence of Mycobacterium tuberculosis DNA on polymerase chain reaction testing.

Diagnosis:

Disseminated BCG infection following BCG immunotherapy for TCC of the bladder. (BCGosis)

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