A Bovine Conundrum

This episode discusses the case of an 85-year-old man with a history of hypertension and fairly recently diagnosed bladder cancer who presents with oligoarticular asymmetric inflammatory arthritis. Explore the details of this case and learn how bacillus Calmette-Guérin and reactive arthritis are related in this diagnostic conundrum. Intro :10 An 85-year-old man with a history of hypertension and recently diagnosed bladder cancer presents with oligoarticular asymmetric inflammatory arthritis :18 Details of his cancer history :32 How BCG (bacillus Calmette-Guérin) is used for superficial bladder cancer :53 Patient wakes with acute onset, rapidly progressing joint pain 1:21 Results of synovial aspiration of his right wrist 2:06 Physical exam findings and patient history 2:24 Discharged from outside hospital 2:53 Outpatient rheumatologist orders autoimmune serologies 3:03 Second hospital admission 3:24 Infectious disease evaluation 4:25 Patient presents to Cleveland Clinic 4:54 What do we have? 6:18 The main concern is he's been instilled with bacteria 6:45 Could this be a reactive arthritis? 7:18 History of BCG 7:45 What do we know about what happens to these patients? 10:28 How do we define disseminated BCG infection vs. a reactive arthritis? 10:58 A single institution cohort of disseminated infection after BCG instillation 11:29 Comparing these definitions in our patient 14:34 A look at reactive arthritis 15:07 What do we use to treat these patients? 16:12 A look back at our patient 16:31 Continued treatment with triple therapy 17:05 A diagnostic conundrum 17:32 The diagnosis, in hindsight 18:11 Summary 18:49 We'd love to hear from you! Send your comments/questions to [email protected]. References: Bernini L. Autoimmun Rev. 2013;12:1150-1159. Meyer J. Postgrad Med J. 2002;78:449-454. Pérez-Jacoiste Asín MA. Medicine (Baltimore). 2014;93:236-254. To U. Case Rep Med. 2014;doi:10.1155/2014/362845.