Abstract We report a rare case of Mycobacterium bovis vascular graft infection, nearly two decades after exposure to intravesical Bacillus Calmette–Guérin (BCG) therapy. A male in his 90 s with a notable history of BCG therapy for bladder cancer 18 years prior presented with chronic left leg pain and drainage at the site of a left popliteal vascular graft. Routine bacterial and fungal cultures were negative, and symptoms persisted despite multiple courses of broad-spectrum antibiotic therapy. Graft removal revealed a wound tunneling to bone. Acid-fast bacilli (AFB) cultures were collected and grew Mycobacterium bovis, confirmed as BCG strain via whole genome sequencing. The patient was initially started on four-drug therapy, and subsequently transitioned to dual rifampin and isoniazid for a total of nine months, with excellent clinical response. This case illustrates the potential for extreme latency of M. bovis BCG infection and highlights the clinical importance of considering remote BCG exposure in patients with culture-negative vascular graft infections, particularly in the presence of caseating tissue or chronic inflammation.
Khan et al. (Thu,) studied this question.