<i>Mycobacterium bovis</i> Granulomatous Pachymeningitis after Intravesical BCG Immunotherapy
Bibliographic record
Abstract
Intravesical adjuvant administration of attenuated live strain of Mycobacterium bovis or the bacillus Calmette-Guerin (BCG) is the choice of care for high-grade non-muscle invasive bladder cancer after resection. 1BCG vaccine is also used to prevent Mycobacterium tuberculosis (TB) in many countries.Although mostly safe, intravesical injected BCG may stay in the urinary tract for more than a year and cause local or disseminated infection, especially in immunocompromised patients.Urinary tract-psoas abscess, pulmonary TB, mycotic aortic aneurysm, bone-joint infections, and even Guillain-Barre syndrome are some of the reported conditions. 2 We present a rare and possibly the first reported case of M. bovis intradural, extramedullary granulomas following BCG immunotherapy.A 67-year-old male with a history of bladder cancer status post-transurethral resection of bladder tumor and adjuvant intravesical BCG administration in 2017 presented with altered mental status, back pain, tingling sensation in lower extremities, and back pain 2 years later.MRI showed a large intradural enhancing thoracolumbar mass (Figure 1).Lumbar puncture revealed elevated leukocyte of 435/mm 3 , protein of 2907 mg/dl, and low glucose of 28 mg/dl.He underwent L1-L4 laminectomies for intradural debridement and biopsy, with pathology showing soft tissue with chronic necrotizing granulomatous inflammation with no evidence of microorganisms.However, a broad range polymerase chain reaction (PCR) test and cultures were positive for M. bovis, most likely from his previous BCG therapy.Follow-up MRI (Figure 2) showed posterior epidural rimenhancing fluid collections from L2 to S1 levels.There was also pachymeningeal enhancement and high T2 signal of lower spinal cord.Proteinaceous material surrounding the cauda equina nerve roots was seen.M. bovis is a causative agent of TB in cattle but can cause TB-like infection in humans.Diagnosis of TB requires a positive culture, PCR positivity, or a biopsy showing caseating granulomas.BCG is the mainstay adjuvant therapy of bladder cancer.Osteomyelitis (Pott's disease), cerebral tuberculoma, ocular infections, cauda equina nerve root involvement, and other systemic complications have been described in the literature following BCG therapy.Although cases of M. tuberculosis spinal tuberculomas or granulomas have been described, there
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".