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REACTIVE ARTHRITIS TO ONCOBCG: CASE REPORT

Introdução, Material, Método, Resultados, Discussão e Conclusões

Case presentation: Male, 59 years old, white, a smoker in abstinence and historic of systemic arterial hypertension and benign prostatic hyperplasia presented, in 2018, hematuria. After investigation, was diagnosed with high-grade papillary urothelial carcinoma (T1N0M0). Therapy with Bacillus Calmette-Guerin (oncoBCG) was indicated; after the third dose, bilateral ocular hyperemia, arthralgia, joint edema, and stiffness occurred, besides important asthenia. The patient was evaluated with conjunctivitis and oligoarthritis of small and large asymmetric joints; no mucocutaneous lesion, fever, alteration of bowel habit or urethritis. Presented elevated inflammatory evidence and antigen of histocompatibility complex HLA-B27, besides rheumatic autoantibodies negatives. Admitted for pain control, with the need for intravenous corticosteroid therapy. After recovery, initiated outpatient treatment with Methotrexate with significant improvement of the articular and constitutional symptoms and currently, in gradual withdrawal corticosteroid therapy; the treatment with oncoBCG was discontinued. The possibility for infectious causes that explain the case was excluded in the final tests, resting only the oncoBCG to explain the reaction causing. At the moment, the patient is without evidence of disease and does not require complementary medication.
Discussion: Reactive arthritis (Reiter Syndrome) usually occurs within 1-3 weeks after a urogenital/gastrointestinal infection but may also elapse from the standard treatment for bladder cancer. It manifests itself with the involvement of the articular, mucocutaneous and ocular system. It has a prevalence of 15.4% in cases of arthritis but is rare when associated with oncoBCG – 0.5-1% off complications (5%). Arthritis is asymmetric, predominant in lower limbs and variable severity; mucocutaneous involvement presents as bullous lesions; conjunctivitis is the most common ocular manifestation.
Final comments: Non-invasive bladder cancer has a prevalence of 3% in men and 1.4% in women. The standard treatment is transurethral resection followed by oncoBCG in patients presenting tumors of high-grade, multiple lesions or greater than 3cm. From a laboratory, there is no specific confirmatory examination; the inflammatory tests, in general, are high, being proportional to the severity of the disease, and the presence of the HLA-B27 assists the diagnosis. Differential diagnosis with other rheumatic pathologies should be considered.

Palavras Chave

Bladder cancer; Reactive arthritis; Rare event