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

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. (www.actabiomedica.it).