HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS AFTER INTRAVESICAL BCG ADMINISTRATION FOR BLADDER CANCER PRESENTING WITH MULTIORGAN FAILURE

  1. GD Liatsos
  2. Georgia Manousopoulou
  3. Aikaterini Poulaki
  4. Agapi Iliaki
  5. Ilias Mariolis
  6. Dimitrios Vassilopoulos

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Abstract

Bacillus Calmette-Guérin (BCG), is administered intravesically as an adjuvant immunotherapy for the treatment of non-muscle invasive bladder cancer. While mild non-infectious problems can occur in up to 85% of cases, significant local and systemic complications have been reported in 1-5% of cases. We report the case of a patient with superficial bladder cancer who developed multiorgan failure after intravesical BCG instillation including the kidney and liver with subsequent haemophagocytic lymphohistiocytosis. Our case illustrates the first reported combination of secondary haemophagocytic lymphohistiocytosis with severe renal and liver failure after BCG immunotherapy for bladder carcinoma. Treatment strategy is discussed.

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  1. Access Microbiology

    Thank you very much for submitting your revised manuscript to Access Microbiology and applying the reviewers' suggestions. I am happy to let you know that you manuscript has now been accepted for publication. Congratulations!

  2. Version published to 10.1099/acmi.0.000670.v2 on Access Microbiology
  3. Access Microbiology

    The manuscript has been reviewed by two experts in the field, who have raised minor concerns that would need to be fixed prior to publication. This includes suggestions of text structure rearrangements and additional aspects to discuss, which will need to be specifically amended. Additionally, the title needs to be amended by using a standard letter casing.

  4. Access Microbiology

    Comments to Author

    1. Description of the case: Satisfactory. 2. Presentation of results: NA. 3. How the style and organization of the paper communicates and represents key findings: Good. 4. Literature analysis or discussion: Good. 5. Any other relevant comments: The manuscript is well-written; however, I have two comments: In the discussion, page 4, line 136: Kindly correct the word manifestation to manifestations. In the discussion, page 4, line 139: Is the number (11) a reference number? If so, please write it in the same format as other references.

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  5. Version published to 10.1099/acmi.0.000670.v3 on Access Microbiology
  6. Access Microbiology

    Comments to Author

    1. Description of the case(s) Good, may benefit from stating the bladder cancer diagnosis first, and then progressing to the BCG instillations, and why these were initiated. 2. Presentation of results This is a case report. BM images are excellent. 3. How the style and organization of the paper communicates and represents key findings Reorganize content in the Introduction and the Discussion 4. Literature analysis or discussion Satisfactory. 5. Any other relevant comments The case report is indeed interesting. Furthermore, the successful recovery of the patient merits highlight of the authors management. The abstract seems to contain more introductory information than the Introduction itself. Suggest moving the first part of the Discussion to the Introduction. Discussion should be to discuss their findings. Was HLH due to BCG, or something that developed in the patient, leading to a severe clinical scenario of BCG infection in a patient with a severe immunedysregulation due to the HLH? The before the last paragraph of the Discussion need to be rephrased. Still discussing the multiorgan failure, but without making emphasis that this is the first report of it. Some aspects still need to be discussed, such as the age of the patient and the fact that this didn't occur in the previous 8 instillations with BCG.

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  7. Version published to 10.1099/acmi.0.000670.v1 on Access Microbiology