Dactilitis and oligoarthritis after BCG immunotherapy in a patient affected by bladder cancer

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The treatment of bladder cancer with Bacillus of Calmette-Guerin (BCG) immunotherapy can induce the appearance of a reactive disorder. The Authors describe a 55-year-old male patient with bladder cancer treated with endovesical instillation of BCG immunotherapy, followed after the fifth application by asymmetric oligoarthritis and dactilitis. The observed positivity of both HLA-B27 and HLA-B51 antigens reinforces the hypothesis of a reactive form, possibly through "molecular mimicry" mechanism. The discontinuation of BCG instillation along which a therapeutic attempt with NSAD failed to improve the rheumatic manifestation, which completely remitted after a four-month course of oral steroids. No relapses of joint and tendon involvement was observed during the following five-month period. The clinico- pathogenetic implications suggested by this case are discussed.

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Manzini, C., Bernardini, L., Elkhaldi, N., Mascia, M., & Ferri, C. (2006). Dactilitis and oligoarthritis after BCG immunotherapy in a patient affected by bladder cancer. Reumatismo, 58(3), 230–232. https://doi.org/10.4081/reumatismo.2006.230