Tuberculous discitis following traumatic intravesical Bacillus Calmette-Guérin treatment: illustrative case

BACKGROUND Tuberculous spondylitis/discitis is a rare presentation of mycobacterial infection, typically secondary to Mycobacterium tuberculosis ; however, patients receiving intravesical Bacillus Calmette-Guérin (BCG) are at risk of developing tuberculous spondylitis secondary to Mycobacterium bovis . OBSERVATIONS This article reports a rare case of tuberculous spondylitis/discitis with a recent history of traumatic intravesical BCG therapy for superficial bladder cancer, which required surgical decompression of an abscess in the setting of intractable back pain. LESSONS This case highlights the importance of a focused, yet relevant understanding of a patient’s history in the development of one’s differential diagnosis and overall surgical management. This patient, with a recent history of traumatic BCG instillation, presented at a short interval for intractable back pain and underwent surgery for discitis and epidural abscess without immediate speciation. Importantly, patients with likely infectious spondylitis/discitis, without obvious bacterial speciation, who have any history of intravesical BCG treatment should be considered for tuberculous etiology. https://thejns.org/doi/10.3171/CASE26705