Doença de Pott após tratamento intravesical com Mycobacterium bovis BCG

Published on Jan 1, 2016in Galicia Clínica
S. Tannira , Pedro Figueiredo15
Estimated H-index: 15
+ 3 AuthorsA. Mello Silva
Abstract
portuguesOs autores descrevem um caso de osteomielite da coluna vertebral a M. Bovis BCG num doente de 83 anos, com historia previa de carcinoma urotelial da bexiga, submetido a resseccao trans-uretral e imunoterapia com BCG intravesical durante 3 anos. Cinco anos apos realizacao desta terapeutica, o doente desenvolveu quadro de paraparesia progressiva, tendo realizado ressonância magnetica que revelou lesao osteolitica ao nivel de D10 e D11, sugestiva de infiltracao secundaria/infecciosa. Foi submetido a laminectomia de D10 a L1 e vertebroplastia D11 a D12. O exame directo foi positivo para micobacterias e a microscopia da lesao osteolitica dorsal identificou inflamacao granulomatosa com presenca de celulas gigantes, tendo iniciado terapeutica com Isoniazida, Rifampicina, Pirazinamida e Etambutol, com melhoria clinica. EnglishThe authers describe a case of M. bovis BCG vertebral osteomyelitis in a patient of 83 years with a previous history of urothelial bladder carcinoma, underwent trans-urethral resection and intravesical BCG immunotherapy for 3 years. Five years post-treatment, the patient developed progressive paraparesis. Magnetic resonance imaging revealed lytic lesion at the level of D10 and D11, suggestive of secondary/infectious infiltration. Laminectomy of D10-L1 and vertebroplasty of D11-D12 has been performed. Direct smear examination for mycobacteria showed to be positive. Microscopy of dorsal osteolytic lesion identified granulomatous inflammation with giant cells. The patient showed clinical improvment after treatment with isoniazid, rifampicin, pyrazinamide and ethambutol.
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