Prosthetic hip joint infection by Bacillus Calmette-Guerin therapy following intravesical instillation for bladder cancer identified using whole-genome sequencing: a case report

• Published in: BMC infectious diseases 2021-02, Vol.21 (1), p.151-5, Article 151
• Main Authors: Riste, Michael, Davda, Pretin, Smith, E Grace, Wyllie, David H, Dedicoat, Martin, Jog, Simantini, Laird, Steven, Langman, Gerald, Jenkins, Neil, Stevenson, Jonathan, O'Shea, Matthew K
• Format: Article
• Language: English
• Subjects: Administration, Intravesical; Aged; Antibiotics; Arthritis, Infectious - diagnosis; Arthritis, Infectious - etiology; Arthritis, Infectious - therapy; Artificial hip joints; Bacillus; Bacillus Calmette-Guerin; Bacillus Calmette-Guerin vaccine; BCG; BCG Vaccine - administration & dosage; BCG Vaccine - adverse effects; BCG Vaccine - genetics; BCG Vaccine - isolation & purification; BCG vaccines; Bladder; Bladder cancer; Cancer; Cancer therapies; Care and treatment; Case Report; Case reports; Case studies; Complications; Complications and side effects; Deoxyribonucleic acid; Diagnosis; DNA; DNA sequencing; Drug therapy; Gene sequencing; Genome, Bacterial - genetics; Genomes; Hip; Hip Prosthesis - adverse effects; Hip Prosthesis - microbiology; Humans; Infections; Infectious bone diseases; Infectious diseases; Intravesical BCG therapy; Joint diseases; Male; Mycobacterium bovis; Nucleotide sequencing; Pain; Polyethylene; Polymerase chain reaction; Prostheses; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - therapy; Prosthetic joint infection; Surgery; Therapy; Treatment Outcome; Urinary Bladder Neoplasms - drug therapy; Whole genome sequencing
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-05831-3

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. 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. 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.