Reactive Arthritis - A Rare Complication of Intravesical BCG Instillation

Reactive arthritis (ReA) with the classic triad of arthritis, conjunctivitis and urethritis, previously termed Reiter's syndrome, is a systemic illness, usually induced by genitourinary or gastrointestinal infections. However, it can be a rare complication of intravesical Bacillus Calmette-Guérin instillation (iBCG), a therapy prepared from attenuated strains of Mycobacterium bovis, a common and effective treatment for carcinoma in situ of the bladder (CisB). We report a case of a patient with CisB who developed ReA after iBCG. The symptoms resolved completely with corticosteroids. iBCG was stopped with no recurrence of carcinoma within 2 years.

Learning points: ReA is an aseptic arthritis, usually triggered by genitourinary or gastrointestinal infections, generally in individuals positive for HLA-B27.Septic arthritis and microcrystalline arthritis can mimic ReA and they must be ruled out with arthrocentesis.ReA may be considered as a complication in patients under iBCG.