DOI: 10.12890/2022_003395

Secondary Haemophagocytic Lymphohistiocytosis Syndrome (HLH) After Intravesical Instillation of Bacillus Calmette-Guérin (BCG): A Case Report and Review of the Literature

Authors

  • Konstantinos Manganas First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Athens, Greece
  • Angelara Maria First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Athens, Greece
  • Ioanna Bountzona First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Athens, Greece
  • George Karamanakos First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Athens, Greece
  • Angelos Toskas First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Athens, Greece

kmagganas92@gmail.com

Keywords

BCGitis, HLH syndrome, intravesical BCG instillation

Abstract

Intravesical bacillus Calmette-Guérin (BCG) instillation is widely used for the treatment of superficial bladder cancer. BCGitis is a serious immune-mediated complication with systematic manifestations and a high mortality rate. Here, we describe a case of a 64-year-old male patient who presented with haemophagocytic lymphohistiocytosis syndrome (HLH) after BCG instillation and was effectively treated with high-dose dexamethasone, intravenous immunoglobulins and anti-tuberculosis treatment.

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References

  1. Alhunaidi O, Zlotta AR. The use of intravesical BCG in urothelial carcinoma of the bladder. Ecancermedicalscience> 2019;13:905.
  2. Sharma V, Thakur APS, Ramasamy V, Shukla P.K, Solanki F.S, Choudhary A et al. Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience. Afr J Urol 2020;26:90.
  3. Morales A, Eidinger D, Bruce AW. Intracavitary bacillus Calmette-Guerin in the treatment of superficial bladder tumors. J Urol 1976;116:180–182.
  4. Larsen ES, Nordholm AC, Lillebaek T, Holden IK, Johansen IS. The epidemiology of bacille Calmette-Guérin infections after bladder instillation from 2002 through 2017: a nationwide retrospective cohort study. BJU Int> 2019 Dec;124(6):910-916.
  5. Lamm DL, van der Meijden PM, Morales A, Brosman SA, Catalona WJ, Herr HW, et al. Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer. J Urol 1992 Mar;147(3):596-600.
  6. Pérez-Jacoiste Asín MA, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Tejido Á, San Juan R, et al. Bacillus Calmette-Guérin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: incidence, risk factors, and outcome in a single-institution series and review of the literature. Medicine (Baltimore) 2014 Oct;93(17):236-254.
  7. Padhi S, Ravichandran K, Sahoo J, Varghese RG, Basheer A Hemophagocytic lymphohistiocytosis: an unusual complication in disseminated Mycobacterium tuberculosis. Lung India 2015;32(6):593-601.
  8. Misra S, Gupta A, Symes A, Duncan J. Haemophagocytic syndrome after intravesical bacille Calmette-Guérin instillation. Scand J Urol 2014 Jun;48(3):328-30.
  9. Schleinitz N, Bernit E, Harle JR. Severe hemophagocytic syndrome after intravesical BCG instillation. Am J Med 2002 May;112(7):593-4.
  10. Thevenot T, Di Martino V, Lagrange A, Petrella T, Faucher J-F, Fontan J, et al. Granulomatous hepatitis and hemophagocytic syndrome after bacillus Calmette-Guerin bladder instillation. Gastroenterol Clin Biol 2006 Mar;30(3):480-2.

Published

2022-10-21

Issue

Vol. 9 No. 10 (2022)

How to Cite

1.
Manganas K, Maria A, Bountzona I, Karamanakos G, Toskas A. Secondary Haemophagocytic Lymphohistiocytosis Syndrome (HLH) After Intravesical Instillation of Bacillus Calmette-Guérin (BCG): A Case Report and Review of the Literature. EJCRIM [Internet]. 2022 Oct. 21 [cited 2026 Nov. 3];9(10). Available from: https://ejcrim.com/index.php/ejcrim/article/view/3395