An 89-year-old man was seen for worsening left hip pain. He had a history of bladder cancer status post-transurethral resection of bladder tumor followed by intravesicular instillations of bacillus Calmette-Guérin (BCG). About one year later, he developed worsening pain in his left prosthetic hip that continued to worsen over the next three months. A computed tomography scan of the hip revealed loosening hardware and periprosthetic fluid collection. Aspiration and operative cultures revealed Mycobacterium bovis BCG. Susceptibility testing revealed resistance to pyrazinamide. The patient underwent a surgical washout with retention of hardware. Treatment with isoniazid, rifampin, ethambutol, and pyridoxine was initiated. This case highlights an extremely rare and delayed complication of intravesicular BCG leading to prosthetic joint infection.

Legionella pneumophila is the most common cause of atypical pneumonia presenting with rhabdomyolysis. A case is reviewed involving a previously healthy 48-year-old man with Legionnaires’ Disease presenting with a peak CPK level of 1.07 million U/L, the highest degree of elevation that has been reported.

Herein, we report two additional cases of extreme pyrexia and rapid death due to Staphylococcus aureus infection. The organisms produced a variant superantigen, cross-reactive with toxic shock syndrome toxin-1 (TSST-1 cross-reactive superantigen SE-like X), which we purport to be the causative agent for this syndrome.