A 60-year-old patient diagnosed with multiple high-grade papillary urothelial carcinoma (T1 G2-3) treated by bladder TUR on 12/01/05 and subsequent TUR for probable recurrence on 9/05/05 (AP: Chronic inflammatory tissue) for which complementary treatment was indicated with BCG instillations at a weekly dose, for six weeks he came to our centre with a constitutional picture of deterioration of the general condition with marked asthenia, fever of up to 39.5 ºC, predominantly in the evening, joint pain starting in the right foot, with subsequent involvement of the left foot, ankles, wrists, hands and fingers (symmetrical and cumulative involvement) together with conjunctivitis with marked ocular redness and purulent discharge. No aphthous ulcers or other oral or genital lesions reported. No other symptoms or signs of infectious locality.
Laboratory tests showed marked leukocytosis (22,180 with 80% neutrophils), ESR 100 at the 2nd hour and CRP 49 mg/dl. In addition, there was an alteration of liver enzymes.
Serology for hepatitis was negative, as well as for Yersinia and Chlamydia. Blood cultures, urine cultures and stool cultures were negative. Culture of Koch's bacillus in urine with negative Kinyoun's stain. HLA B27 and RF negative.
Subsequently, arthrocentesis of the right ankle was performed with inflammatory fluid. Culture and crystals were negative.
Given the negative results of the tests performed and the arthrocentesis, as a differential diagnosis, we considered polyarthritis secondary to BCG instillations.
We started treatment with indomethacin and corticosteroids (methylprednisolone 40 mg) with a good clinical and analytical response. On discharge the patient continued treatment with indomethacin 75 mg (1-0-1) for 21 days.
The patient came back for a check-up after three months and was asymptomatic.