704Mycobacterium bovis vertebral osteomyelitis due to intravesical Bacillus Calmette-Guérin (BCG): A rare complication of a common therapy

Background. Intravesical Bacillus Calmette-Guérin (BCG) is a well known and effective therapy for bladder carcinoma. Complications from BCG are very uncommon. Vertebral osteomyelitis secondary to BCG is exceedingly rare. Methods. We report a case of vertebral osteomyelitis due to Mycobacterium bovis following intravesical BCG therapy. We then present a review of all the reported cases of BCG-induced vertebral osteomyelitis. Results. The patient is a seventy-nine year old male with history of bladder cancer for which he had transurethral resection done. This was followed by intravesical therapy with BCG. A month after his last BCG treatment, he started developing low back pain. A computerized tomographic (CT) scan of the lower back showed a lytic lesion at the level of the twelfth thoracic (T12) and first lumbar (L1) vertebrae. Patient’s back pain progressively worsened and he subsequently developed right sided foot drop. A CT myelogram showed significant destruction of the T12 and L1 vertebral bodies and severe spinal canal stenosis at the T12-L1 level. The patient underwent T8-L4 posterior arthrodesis and T12-L1 corpectomies. Cultures from the spine grew Mycobacterium bovis, which as expected, was resistant to pyrazinamide and sensitive to all other first line antimycobacterial agents. Patient did well in the postoperative period and was discharged on triple therapy with isoniazid, rifampin and ethambutol, which he is scheduled to receive for a twelve month course. A review of the English literature revealed a total of sixteen cases of vertebral osteomyelitis due to M. bovis secondary to intravesical BCG therapy. All the patients were male, with an age range from 64 to 94 years, with a mean of 75 years. The time from last BCG treatment to onset of symptoms ranged from two weeks to eleven years, with a mean of 28 months. Most of the patients underwent percutaneous or open drainage, along with antimicrobial therapy. The most frequently used combination was isoniazid, rifampin and ethambutol, for twelve months. Conclusion. Vertebral osteomyelitis due to Mycobacterium bovis is a very rare complication of intravesical BCG therapy. A combination of surgical debridement and prolonged antibiotic therapy offer a favorable prognosis. Disclosures. All authors: No reported disclosures.