Mycobacterium bovis BCG causing vertebral osteomyelitis (Pott's disease) following intravesical BCG therapy.

We report a case of Mycobacterium bovis BCG vertebral osteomyelitis in a 79-year-old man 2.5 years after intravesical BCG therapy for bladder cancer. The recovered isolate resembled M. tuberculosis biochemically, but resistance to pyrazinamide (PZA) rendered that diagnosis suspect. High-pressure liquid chromatographic studies confirmed the diagnosis of M. bovis BCG infection. The patient was originally started on a four-drug antituberculous regimen of isoniazid, rifampin, ethambutol, and PZA. When susceptibility studies were reported, the regimen was changed to isoniazid and rifampin for 12 months. Subsequently, the patient was transferred to a skilled nursing facility for 3 months, where he underwent intensive physical therapy. Although extravesical adverse reactions are rare, clinicians and clinical microbiologists need to be aware of the possibility of disseminated infection by M. bovis BCG in the appropriate setting of clinical history, physical examination, and laboratory investigation.

Secondary carcinomas of the kidney.

We reviewed 81 cases of secondary carcinoma of the kidney, the clinical detection of which still remains a challenge. All lymphomas were excluded from this study. There was no direct relationship of the cell type of the primary tumor to the degree of renal invasion. Generally, functional renal impairment was not a significant entity unless renal destruction was extreme. Ureteral obstruction was infrequent in this group. Angiography was helpful in determining the metastatic spread as well as the degree of renal involvement. The varied aspects of the primary tumor's pathophysiology have been a continuing challenge to early detection and successful therapy in any patient. Furthermore, the anatomic location and the peculiar biologic behavior of some primary tumors may make the clinical course and response to treatment unpredictable. Lungs, stomach, breast and contralateral kidney remain the common primary sources of malignancy likely to metastasize to the kidney, with an apparent period of occult growth and further metastases before symptoms appear, The possible delay in seeking medical attention, that is chemotherapy and radiation, as well as the aggressiveness of the primary tumor itself may contribute to the poor survival noted in this study despite the use of various therapeutic modalities.