scholarly journals Prosthetic joint infection: an extremely rare complication of intravesicular BCG therapy

2019 ◽  
Vol 12 (12) ◽  
pp. e232809 ◽  
Author(s):  
Michael Storandt ◽  
Avish Nagpal
Keyword(s):  
Rare Complication ◽  
Joint Infection ◽  
Acid Fast Bacillus ◽  
Joint Effusion ◽  
Urothelial Bladder Carcinoma ◽  
Prosthetic Joint ◽  
Bcg Therapy ◽  
Urothelial Bladder ◽  
History Of ◽  
The Right

A 66-year-old man was seen in clinic due to concerns of tuberculosis of the right hip. He had a history of urothelial bladder carcinoma, which was treated via transurethral resection followed by intravesicular instillations of Mycobacterium bovis BCG (BCG). A few months later, he developed slowly worsening pain over his prosthetic right hip, and it was recommended he undergo surgical revision. During surgery, joint effusion was noted and synovial fluid was sent for bacterial and mycobacterial cultures, growing an acid-fast bacillus after 3 weeks, identified as Mycobacterium tuberculosis complex via nucleic acid probe. Susceptibility testing revealed resistance to pyrazinamide, which is typically seen in M. bovis. PCR confirmed the diagnosis of BCG infection. The patient was treated with isoniazid, rifampin and ethambutol, which he tolerated well. This case highlights the challenges associated with diagnosis and management of this rare complication of a commonly used therapy.

scholarly journals Mycobacterium bovis prosthetic joint infection following intravesical instillation of BCG for bladder cancer

2019 ◽  
Vol 12 (12) ◽  
pp. e231830 ◽  
Author(s):  
Ashka Patel ◽  
Joel Elzweig
Keyword(s):  
Bladder Cancer ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Fluid Collection ◽  
Acid Fast Bacillus ◽  
Intravesical Instillation ◽  
Susceptibility Data ◽  
Prosthetic Joint ◽  
Bcg Therapy ◽  
History Of

A 91-year-old man with a history of intravesicular BCG therapy for recurrent bladder cancer and bilateral total hip arthroplasty (THA) presented with left hip pain. He was noted to have a fluid collection over the left lateral hip and hip X-ray showed loosening of the prosthetic hip stem indicative of a prosthetic joint infection (PJI). He subsequently underwent removal of the THA and insertion of an antibiotic spacer. He was discharged on intravenous ceftriaxone for presumed culture negative PJI. Intraoperative acid fast bacillus culture later grew Mycobacterium tuberculosis complex, which was then differentiated to M. bovis. The M. bovis infection was thought to be a complication of the patient’s prior BCG therapy. He was initially started on isoniazid, rifampin, pyrazinamide and ethambutol pending cultures and sensitivities; pyrazinamide was discontinued after M. bovis was isolated on culture and susceptibility data confirmed the expected inherent resistance of M. bovis to pyrazinamide. The patient underwent successful THA revision and remains symptom-free at 1 year.

scholarly journals Prosthetic Joint Infection due toMycobacterium bovisafter Intravesical Instillation of Bacillus Calmette-Guerin (BCG)

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Eric Gomez ◽  
Tom Chiang ◽  
Ted Louie ◽  
Madhavi Ponnapalli ◽  
Robert Eng ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Intravesical Instillation ◽  
Bacillus Calmette Guerin ◽  
Urothelial Bladder Carcinoma ◽  
Prosthetic Joint ◽  
Urothelial Bladder ◽  
Bladder Instillation ◽  
Uncommon Case ◽  
Systemic Infections

Intravesical instillation of Bacillus Calmette-Guerin (BCG) is a treatment to prevent recurrence of superficial urothelial bladder carcinoma. Complications after bladder instillation of BCG have been reported including locally invasive and systemic infections due to dissemination ofMycobacterium bovisfrom the bladder. We present an uncommon case and literature review of prosthetic joint infection due toM. bovisafter intravesical BCG treatment of bladder cancer.

Late prosthetic shoulder joint infection due to Actinomyces neuii in an adult man

2020 ◽  
Vol 13 (9) ◽  
pp. e236350
Author(s):  
Benjamin C Chen ◽  
Takaaki Kobayashi ◽  
Bradley Ford ◽  
Poorani Sekar
Keyword(s):  
Shoulder Joint ◽  
Clinical Symptoms ◽  
Reverse Shoulder Arthroplasty ◽  
Joint Infection ◽  
Gram Stain ◽  
Prosthetic Joint ◽  
Irrigation And Debridement ◽  
History Of ◽  
The Right ◽  
Slow Growing

A 72-year-old man with a history of right reverse shoulder arthroplasty presented with a 1-month history of erythema, pain and drainage from the right shoulder. Arthrocentesis was performed and synovial fluid gram stain revealed gram-positive rods. Clinical diagnosis of prosthetic shoulder joint infection was made. Orthopaedic surgeons performed irrigation and debridement with resection of the right shoulder prothesis and implantation of an antimicrobial spacer. Operative cultures grew Actinomyces neuii. The patient was treated with 6 weeks of ceftriaxone with improvement in both clinical symptoms and laboratory values. Actinomyces species remain a rare cause of late prosthetic joint infection (PJI) due to their slow growing and indolent course. While generalised actinomycosis is often treated with 6–12 months of antibiotics, the treatment course of Actinomyces PJI is not well characterised, with some sources suggesting a minimum of 6 weeks of antimicrobial therapy.

Hepatic brucelloma: a rare complication of a common zoonotic disease

2020 ◽  
Vol 13 (12) ◽  
pp. e237076
Author(s):  
George Vatidis ◽  
Eirini I Rigopoulou ◽  
Konstantinos Tepetes ◽  
George N Dalekos
Keyword(s):  
Rare Complication ◽  
Surgical Excision ◽  
Coombs Test ◽  
Inflammation Markers ◽  
Laboratory Findings ◽  
Ct Guided ◽  
Rare Manifestation ◽  
Bone Marrow Cultures ◽  
History Of ◽  
The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

A case of Mycobacterium fortuitum prosthetic joint infection successfully treated medically without prosthesis explantation or joint debridement

2021 ◽  
Vol 14 (8) ◽  
pp. e243675
Author(s):  
Maya Ramanathan ◽  
Folusakin Ayoade
Keyword(s):  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Joint Infection ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Mycobacterium Fortuitum ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Prosthetic Joint ◽  
The Right

A 58-year-old man with a history of end-stage degenerative joint disease developed a postsurgical infection at the right hip 4 weeks after hip replacement surgery. He underwent surgical washout of the right hip without opening the joint capsule. Arthrocentesis returned positive for Mycobacterium fortuitum. He was started on antibiotics with the recommendation to remove the prosthesis. The prosthesis was retained. Based on antimicrobial susceptibilities, he was treated with 4 weeks of intravenous therapy using cefoxitin and amikacin and later switched to oral ciprofloxacin and doxycycline for 5 additional months. Eighteen months from his initial hip replacement surgery, he continues to do well. Joint aspiration culture is important to make a diagnosis of prosthetic joint infection (PJI) when periprosthetic culture is not available. In the absence of serious systemic or comorbid joint conditions, PJI due to M. fortuitum can be managed medically without having to remove the prosthesis or debride the joint.

scholarly journals The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

2019 ◽  
Vol 8 (12) ◽  
pp. 2113 ◽  
Author(s):  
Deroche ◽  
Bémer ◽  
Valentin ◽  
Jolivet-Gougeon ◽  
Tandé ◽  
...  
Keyword(s):  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Microbiological Diagnosis ◽  
Joint Infections ◽  
Time To Positivity ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Two Samples ◽  
The Right ◽  
Polymicrobial Infections

Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

Prior hip or knee prosthetic joint infection in another joint increases risk three-fold of prosthetic joint infection after primary total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 91-97 ◽  
Author(s):  
B. P. Chalmers ◽  
J. T. Weston ◽  
D. R. Osmon ◽  
A. D. Hanssen ◽  
D. J. Berry ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Primary Total Knee Arthroplasty ◽  
Study Cohort ◽  
Study Group ◽  
Prosthetic Joint ◽  
Primary Tkas ◽  
History Of ◽  
Total Knee ◽  
Primary Total Knee

Aims There is little information regarding the risk of a patient developing prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) when the patient has previously experienced PJI of a TKA or total hip arthroplasty (THA) in another joint. The goal of this study was to compare the risk of PJI of primary TKA in this patient population against matched controls. Patients and Methods We retrospectively reviewed 95 patients (102 primary TKAs) treated between 2000 and 2014 with a history of PJI in another TKA or THA. A total of 50 patients (53%) were female. Mean age was 69 years (45 to 88) with a mean body mass index (BMI) of 36 kg/m2 (22 to 59). In total, 27% of patients were on chronic antibiotic suppression. Mean follow-up was six years (2 to 16). We 1:3 matched these (for age, sex, BMI, and surgical year) to 306 primary TKAs performed in 306 patients with a THA or TKA of another joint without a subsequent PJI. Competing risk with death was used for statistical analysis. Multivariate analysis was followed to evaluate risk factors for PJI in the study cohort. Results The cumulative incidence of PJI in the study cohort (6.1%) was significantly higher than the matched cohort (2.6%) at ten years (hazard ratio (HR) 3.3; 95% confidence interval 1.18 to 8.97; p = 0.02). Host grade in the study group was not a significant risk factor for PJI. Patients on chronic suppression had a higher rate of PJI (HR 15; p = 0.002), with six of the seven patients developing PJI in the study group being on chronic suppression. The new infecting microorganism was the same as the previous in only two of seven patients. Conclusion In this matched cohort study, patients undergoing a clean primary TKA with a history of TKA or THA PJI in another joint had a three-fold higher risk of PJI compared with matched controls with ten-year cumulative incidence of 6.1%. The risk of PJI was 15-fold higher in patients on chronic antibiotic suppression; further investigation into reasons for this and mitigation strategies are recommended. Cite this article: Bone Joint J 2019;101-B(7 Supple C):91–97

Sudden Bilateral Sensorineural Hearing Loss Following Speedballing

2008 ◽  
Vol 19 (06) ◽  
pp. 461-464 ◽  
Author(s):  
Cynthia G. Fowler ◽  
Jennifer L. King
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Otoacoustic Emissions ◽  
Rare Complication ◽  
Pure Tone Audiometry ◽  
Sensorineural Hearing ◽  
Acoustic Reflexes ◽  
History Of ◽  
Bilateral Sensorineural Hearing Loss ◽  
The Right

Background: Hearing loss is an infrequently-reported consequence of recreational drug abuse. Although there are sporadic reports of hearing loss from heroin and cocaine ingested separately, there are no reports of hearing loss resulting from the combination of both drugs ingested simultaneously in the form of speedballing. Purpose: The purpose of this report is to document a case of bilateral sensorineural hearing loss associated with an episode of speedballing. Research Design: Case Report Data Collection And Analysis: The subject of this report was a 40-year-old man with a 20-year history of substance abuse. Data collected included a case history, pure tone audiometry, tympanometry and acoustic reflexes, and transient evoked otoacoustic emissions. Results: The audiologic evaluation indicated a mild to moderate, relatively flat, bilateral sensorineural hearing loss that was worse in the right ear. Conclusions: A bilateral sensorineural hearing loss involving both cochlear and neural pathology may be a rare complication of cocaine, heroin, or the combination of the two drugs.

scholarly journals Hemichorea-hemiballismus in a patient with hyperglycaemic hyperosmolar state

2020 ◽  
Vol 8 (10) ◽  
pp. 3710
Author(s):  
Rifkatu S. Reng ◽  
Odumodu Kenechukwu ◽  
Shuaibu Ramatu ◽  
Oyakhire Shyngle ◽  
Omonua Special ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Involuntary Movement ◽  
Rare Complication ◽  
Cerebral Atrophy ◽  
Lower Limbs ◽  
High Grade Fever ◽  
Rare Manifestation ◽  
History Of ◽  
Hypertensive Woman ◽  
The Right

Hemichorea-hemiballismus (HCHB) is a rare manifestation of hyperglycaemic hyperosmolar state caused by contralateral lesion in basal ganglia. A 74-year-old, known diabetic and hypertensive woman presented with one-week history of high-grade fever and loss of consciousness associated with involuntary movement of the right upper and lower limbs for 10 hours prior to presentation. Physical examination revealed pyrexia, tachycardia and altered sensorium. Blood glucose was 53.8 mmol/l, hemoglobin A1c (Hb A1c) 9.9% and brain computed tomography (CT) scan showed cerebral atrophy with bilateral basal ganglia hyperdensities. Escherichia coli was cultured from the urine. She did well on treatment with soluble insulin, rehydration and intravenous ceftriaxone. HCHB is a rare complication seen in patients with poorly controlled diabetes mellitus. This report highlights the reversibility of the disease with prompt diagnosis and appropriate insulin treatment. HCHB should be distinguished from other intracranial pathologies.

scholarly journals Mandibular Metastasis of a Recurrent Poorly Differentiated Urothelial Bladder Carcinoma

2020 ◽  
Vol 10 ◽  
pp. 27
Author(s):  
Georges Aoun ◽  
Elie Hayek ◽  
Ibrahim Nasseh
Keyword(s):  
Bladder Carcinoma ◽  
Panoramic Radiograph ◽  
Final Diagnosis ◽  
Metastatic Lesion ◽  
Radiographic Images ◽  
Urothelial Bladder Carcinoma ◽  
Multiple Imaging ◽  
Oral Neoplasms ◽  
Urothelial Bladder ◽  
The Right

Metastatic lesions to the oral cavity are uncommon; they represent between 1 and 3% of all malignant oral neoplasms. In this article, we report a rare case of metastatic urothelial bladder carcinoma in the mandible detected on oral radiographic images and confirmed with multiple imaging modalities. A 67-year-old woman presented to our clinic suffering from pain in the right side of the mandible with a mild swelling. Panoramic radiograph revealed an ill-defined relatively radiolucent lesion in the right mandibular premolar-canine region presenting with permeative changes. Cone-beam computed tomography showed a relatively hypodense lesion with demineralization, interruption of the buccal cortices, and slight thickening and sclerosis of the buccal cortical bone. The patient was referred for further evaluation including additional advanced imaging radiographic techniques (MRI and PET scan) and clinical and histopathological examinations that lead to a final diagnosis of metastatic lesion from an underlying urothelial bladder carcinoma.

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