A 60-year-old patient diagnosed with multiple high grade urothelial papillary carcinoma (T1 G2-3) treated by transurethral resection of the bladder on 01/12/05 and subsequent transurethral resection of the right foot with a marked asthenia.
No aphthous ulcers or other reported oral or genital lesions.
No other symptoms or signs of infectious locality.
Laboratory tests showed marked leukocytosis (22,180 with 80% neutrophils), VSG 100 at 2nd hour and CRP 49 mg/dl. Liver enzyme abnormalities were added.
Serology for hepatitis negative, as well as for Yersinia and Chlamydia.
Both hemocultive, urocultive and coprocultive negative.
Koch's bacillus culture was negative in urine.
HLA B27 and RF negative.
Subsequently, arthrocentesis of the right ankle with fluid of inflammatory characteristics was performed.
Culture and negative crystals.
Given the negativity of the tests performed and arthrocentesis, as a differential diagnosis, we propose polyarthritis secondary to BCG instillations.
We started treatment with indomethacin and corticosteroids (methylprednisolone 40 mg) with good clinical and analytical response.
At discharge, the patient continued treatment with indomethacin 75 mg (1-0-1) for 21 days.
The patient came for review after three months, being asymptomatic of his disease.
