Hemophagocytic lymphohistiocytosis and pulmonary embolism caused by bacillus Calmette-Guerin intravesical instillation

Antonio Fabozzi; Gianluca Paciucci; Emma Repaci; Alessandra Iacovelli; Luigi Panza; Ambra Migliarini; Cristina Santoro; Paolo Palange

doi:10.23750/abm.v95i4.15527

Hemophagocytic lymphohistiocytosis and pulmonary embolism caused by bacillus Calmette-Guerin intravesical instillation

Authors

Antonio Fabozzi Sapienza University of Rome https://orcid.org/0009-0006-6070-428X
Gianluca Paciucci Department of Public Health and Infectious Diseases, Division of Pneumology, “Sapienza” University of Rome, Italy
Emma Repaci Department of Public Health and Infectious Diseases, Division of Pneumology, “Sapienza” University of Rome, Italy
Alessandra Iacovelli Department of Public Health and Infectious Diseases, Division of Pneumology, “Sapienza” University of Rome, Italy https://orcid.org/0000-0002-7103-7842
Luigi Panza Department of Public Health and Infectious Diseases, Division of Pneumology, “Sapienza” University of Rome, Italy
Ambra Migliarini Department of Public Health and Infectious Diseases, Division of Pneumology, “Sapienza” University of Rome, Italy
Cristina Santoro Department of Translational and Precision Medicine, Division of Hematology, “Sapienza” University of Rome, Italy
Paolo Palange Department of Public Health and Infectious Diseases, Division of Pneumology, “Sapienza” University of Rome

DOI: https://doi.org/10.23750/abm.v95i4.15527

Keywords:

Pulmonary Embolism, Hemophagocytic Lymphohistiocytosis, Bacillus Calmette-Guerin, Bladder Carcinoma, Respiratory Failure, Cytopenia

Abstract

Current international guidelines for bladder carcinoma recommend the use of intravesical instillations of chemotherapeutic agents, including bacillus Calmette-Guérin, for the prevention of recurrences in high-grade non-muscle-invasive bladder carcinomas. Treatment with Bacillus Calmette-Guérin is generally well-tolerated. Usually, adverse effects are mild and reversible with discontinuation of therapy. Severe adverse reactions are rare and may include hemophagocytic lymphohistiocytosis, even only few cases have been described none associated with pulmonary embolism. In this report, we describe the case of a 66-year-old patient who develops low-grade (LG) pulmonary embolism and hemophagocytic lymphohistiocytosis after the third session of intravesical instillation. He was treated with high doses of corticosteroid therapy with a restitutio ad integrum of the clinical and laboratory parameters.

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