TY - JOUR
T1 - Prosthetic hip joint infection by Bacillus Calmette-Guerin therapy following intravesical instillation for bladder cancer identified using whole-genome sequencing
T2 - a case report
AU - Riste, Michael
AU - Davda, Pretin
AU - Smith, E Grace
AU - Wyllie, David H
AU - Dedicoat, Martin
AU - Jog, Simantini
AU - Laird, Steven
AU - Langman, Gerald
AU - Jenkins, Neil
AU - Stevenson, Jonathan
AU - O'Shea, Matthew K
PY - 2021/2/5
Y1 - 2021/2/5
N2 - BACKGROUND: Joint replacement is an effective intervention and prosthetic joint infection (PJI) is one of the most serious complications of such surgery. Diagnosis of PJI is often complex and requires multiple modalities of investigation. We describe a rare cause of PJI which highlights these challenges and the role of whole-genome sequencing to achieve a rapid microbiological diagnosis to facilitate prompt and appropriate management.CASE PRESENTATION: A 79-year-old man developed chronic hip pain associated with a soft-tissue mass, fluid collection and sinus adjacent to his eight-year-old hip prosthesis. His symptoms started after intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. Synovasure™ and 16S polymerase chain reaction (PCR) tests were negative, but culture of the periarticular mass and genome sequencing diagnosed BCG infection. He underwent a two-stage joint revision and a prolonged duration of antibiotic therapy which was curative.CONCLUSIONS: BCG PJI after therapeutic exposure can have serious consequences, and awareness of this potential complication, identified from patient history, is essential. In addition, requesting appropriate testing is required, together with recognition that traditional diagnostics may be negative in non-pyogenic PJI. Advanced molecular techniques have a role to enhance the timely management of these infections.
AB - BACKGROUND: Joint replacement is an effective intervention and prosthetic joint infection (PJI) is one of the most serious complications of such surgery. Diagnosis of PJI is often complex and requires multiple modalities of investigation. We describe a rare cause of PJI which highlights these challenges and the role of whole-genome sequencing to achieve a rapid microbiological diagnosis to facilitate prompt and appropriate management.CASE PRESENTATION: A 79-year-old man developed chronic hip pain associated with a soft-tissue mass, fluid collection and sinus adjacent to his eight-year-old hip prosthesis. His symptoms started after intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. Synovasure™ and 16S polymerase chain reaction (PCR) tests were negative, but culture of the periarticular mass and genome sequencing diagnosed BCG infection. He underwent a two-stage joint revision and a prolonged duration of antibiotic therapy which was curative.CONCLUSIONS: BCG PJI after therapeutic exposure can have serious consequences, and awareness of this potential complication, identified from patient history, is essential. In addition, requesting appropriate testing is required, together with recognition that traditional diagnostics may be negative in non-pyogenic PJI. Advanced molecular techniques have a role to enhance the timely management of these infections.
KW - Administration, Intravesical
KW - Aged
KW - Arthritis, Infectious/diagnosis
KW - BCG Vaccine/administration & dosage
KW - Genome, Bacterial/genetics
KW - Hip Prosthesis/adverse effects
KW - Humans
KW - Male
KW - Prosthesis-Related Infections/diagnosis
KW - Treatment Outcome
KW - Urinary Bladder Neoplasms/drug therapy
UR - http://www.scopus.com/inward/record.url?scp=85100518307&partnerID=8YFLogxK
U2 - 10.1186/s12879-021-05831-3
DO - 10.1186/s12879-021-05831-3
M3 - Article
C2 - 33546627
SN - 1471-2334
VL - 21
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 151
ER -
