Refractory arthropathy after intravesical bacillus Calmette-Guerin therapy- Usefulness of isoniazide

Background. Arthritis associated with bacillus usually responds dramaticall y to nonsteroidal antiinflammatory drug therapy. Isoniazid is generally res erved for other complications such as granulomatous hepatitis. Case-report. A 73-year-old man was admitted for fever, arthritis of the knees and right temporomandibular joint, an inflammatory swelling over the left Achilles t endon and bilateral conjunctivitis, The symptoms started in the wake of a c ourse of intravesical bacillus Calmette-Guerin immunotherapy, Laboratory te sts showed evidence of severe inflammation. Cultures of blood. mine and joi nt fluid specimens were negative, as were tests for autoantibodies and sero logic tests for organisms known to cause reactive arthritis. Nonsteroidal a ntiinflammatory therapy was ineffective and glucocorticoid therapy produced only a partial response. All the symptoms resolved under isoniazid therapy In a dosage of 300 mg/day for three months. Conclusion. Use of antitubercu lous agents may be required in some cases of arthritis associated with baci llus Calmette-Guerin immunotherapy, most notably those with severe pyrexia.