Severe hemophagocytic syndrome after intravesical BCG instillation with a fatal outcome

Abstract

Introduction. Hemophagocytic syndrome (HS) after Bacillus Calmette-Guerin (BCG) immunotherapy is extremely rare in everyday practice. Only three times HS have been reported on in the world until now. BCG is used for preventing the recurrence of superficial tumors of the urinary bladder. The first extensive research was conducted by Morales, since when his treatment protocol has been in use. Severe complications are rarely seen. Case report. A 55 year-old patient in bad condition was transferred to Clinic for urology after second round of BCG immunotherapy (Morales protocol) after transurethral electroresection of bladder tumor (TURBT). Computed tomography (CT) of the abdomen and lesser pelvis was performed, which didn?t indicate any clear signs of organ failure or disease. Hemophagocytic syndrome (HS) after BCG immunotherapy was suspected. During further hospitalization, the patien?s already severe condition further deteorited and became more complicated, in the form of the multiorgan disfunction syndrome (MODS). Death occurred on the sixth day of hospitalization. Conclusion. Secondary HS after BCG immunotherapy is an extremely rare disease that is accompanied by a severe general condition of the patient, with many life-threatening complications that can lead to death. We have presented a case of severe HS after BCG immunotherapy that caused death of the patient. This case was unique because, for the first time, the possible causative agent was isolated-Mycobacteria.