RESUMO
Intravesical BCG therapy is commonly used to treat superficial bladder cancer. Although various complications associated with this therapy have been reported, tuberculous spondylitis is uncommon. Here, we report a rare case of tuberculous spondylitis that occurred after intravesical BCG therapy for bladder cancer. A man in his 80s received BCG immunotherapy for bladder cancer and developed low back pain after treatment. Remarkably, he presented with neurological symptoms. Spondylitis was suspected on imaging. CT-guided biopsy was performed to confirm the diagnosis. Consequently, Mycobacterium bovis was identified as the causative pathogen by multiplex PCR. Multidrug therapy, administered for several months, was ineffective. Therefore, surgery was performed through an anterior approach. The symptoms, including low back pain, improved and postoperative C reactive protein tests were within the normal range. Tuberculous spondylitis following BCG therapy should be considered in cases with a history of bladder cancer treatment.
Assuntos
Vacina BCG , Dor Lombar , Mycobacterium bovis , Espondilite , Tuberculose da Coluna Vertebral , Neoplasias da Bexiga Urinária , Humanos , Masculino , Administração Intravesical , Vacina BCG/efeitos adversos , Vacina BCG/uso terapêutico , Quimioterapia Combinada , Hansenostáticos/uso terapêutico , Dor Lombar/diagnóstico por imagem , Dor Lombar/etiologia , Espondilite/diagnóstico , Espondilite/microbiologia , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/microbiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/complicações , Idoso de 80 Anos ou maisRESUMO
Posterior uveitis is not a documented feature of Reiter's disease. We describe here a patient of Reiter's disease, who after a bout of dysentery in January 2002 developed macular edema of the right eye with visual acuity of 6/36. In December 2002, she was found to have phlyctenular conjunctivitis. In June 2004, when she reported with scaly plaques over both palms, repeat ophthalmological examination revealed macular degeneration of the right eye. The simultaneous occurrence of Reiter's disease and macular degeneration in this patient may be fortuitous but the immunological basis of both diseases suggests a possible association.
Assuntos
Artrite Reativa/complicações , Degeneração Macular/etiologia , Anti-Inflamatórios/uso terapêutico , Artrite/tratamento farmacológico , Artrite/etiologia , Fasciíte Plantar/diagnóstico , Fasciíte Plantar/tratamento farmacológico , Feminino , Mãos/patologia , Humanos , Degeneração Macular/tratamento farmacológico , Pessoa de Meia-Idade , Espondilite/terapiaRESUMO
The paper deals with the experimental and clinical study of a new implantable therapeutical means based on biocompatible implants containing the antituberculous agent benemycin. The developed implantant having 4 coatings releases within 10 days as high as 37% of the applied drug benemycin. Then within further 30-70 days, release of the drug is 0.7% a day. The parallel bacteriological studies with the operative material placed in agar made 30-60 days after surgery have indicated that growth retardment in rabbits is 17-30 mm, which corresponds to the levels of rifandin (0.125-1.0 microgram/g tissue. The developed implantant has been used in 130 cases of the surgical treatment of tuberculous spondylitis in order to replace a defect of the body of a vertebra and to make a depot for the antituberculous drug just in the focus. Formation of the pulley at the site of intervention was noted in 57 (43.8%) cases within 5 months and in 62 (47.7%) cases within 10 months. The developed implantant has no toxicity and produces no allergic reactions. The position results of the treatment allows it to be recommended for use in clinical practice.