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

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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.