Bladder cancer patients hospitalized in a medicine ward including three fuo cases following bacillus calmette-guérin immunotherapy

George Liatsos^*, Kalliopi Zioutou, Konstantinos Avramidis, Konstantinos Vamvakaris, Maria Potamiti-Komi, Dimitrios Vassilopoulos
2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens “Hippokration”, Athens, Greece
* Corresponding Author: George Liatsos. Email: email
(This article belongs to the Special Issue: Bladder and Prostate Cancers and Clinical Trials in Urologic Oncology)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.072711

Received 02 September 2025; Accepted 03 February 2026; Published online 21 February 2026

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Abstract

Objectives: Bladder cancer (BC) is a prevalent malignancy with evolving treatment strategies and an increasingly aging patient population, resulting in a growing and complex burden of hospitalizations that extends beyond urological care and remains insufficiently characterized in real-world Internal Medicine settings. This study aimed to analyze the clinical data and outcomes for patients with BC admitted to the medicine ward. Additionally, this research presents three cases of fever of unknown origin, which all exhibited identical clinical and laboratory findings but ultimately resulted in different disease diagnoses. Methods: This retrospective case-series study included all adult patients with BC admitted to the Internal Medicine ward of a tertiary referral hospital between 1 January 2020, and 31 December 2024. Data acquisition was performed through a systematic search of electronic discharge records using the ICD-10 code C67. Data recording involved detailed review of electronic medical records to collect demographic characteristics, clinical history, cancer-related treatments, causes of hospitalization, and outcomes. Three patients previously treated with intravesical Bacillus Calmette–Guérin (iBCG) who presented with fever of unknown origin were analyzed in detail. Data analysis comprised descriptive statistics and comparative testing using Fisher’s exact test and unpaired two-tailed Student’s t-test, with p < 0.05 considered statistically significant. Results: We identified 77 hospitalizations among 67 BC patients who were predominantly male, with a mean age of 75.2. A high prevalence of metabolic syndrome comorbidities and chronic obstructive pulmonary disease was documented. In addition, 31.1% of patients had metastatic BC, 22.9% had a second malignancy, 49.2% had undergone urological surgeries, and 38% had received chemotherapy or immunotherapy other than iBCG. The most common causes of hospitalization were infections, anemia/transfusions, a newly diagnosed metastatic disease, and acute renal failure. The mortality in this cohort was high (17%), with the leading cause of death again being an infection. Among patients who had previously received BCG immunotherapy, three cases of fever of unknown origin were noticed, and despite identical clinical settings, they were identified with different diseases [metastatic disease, infection caused by Bacillus Calmette-Guérin (BCGitis), and Hodgkin’s lymphoma], necessitating individualized therapeutic medications. Conclusions: BC patients in the Internal Medicine unit are generally older adults, often dealing with several chronic conditions and a considerable cancer burden. They are predominantly admitted due to infections, which points to the urgent need for effective infection prevention strategies for this vulnerable population. When BC patients have a fever lasting more than seven days following BCG instillation, which is the maximum duration for self-limited adverse events to occur, regardless of whether an antibiotic regimen has been prescribed, they should consult an internal medicine department for further evaluation.