Fever and leukemoid reaction in bladder cancer: a case report and review of the literature

Background: to discuss the diagnosis, treatment and mechanism of leukemoid reaction in bladder cancer. Methods: : to present and analyze the clinical data of a patient who had urothelial carcinoma complicated with leukemoid reaction Result: The patient had years of smoking history. He underwent six TURBT operations during the time of 31 st Aug 2015 to 26 th Oct 2022. Pathological diagnosis deteriorated from low-grade papillary urothelial carcinoma to high-grade. The patient did not keep to regular bladder perforation or routine follow-up cystoscopy. He also refused radical resection intervention. Last CT results show the following: multiple tumors in the bladder, bilateral ureter bladder entrance invasion, bilateral renal pelvis and ureter dilatation , multiple lymphadenopathy in the pelvis and along the right iliac artery. After cystoscopy examination and urethral catheter was placed, creatinine level gradually decreased. However, body temperature raised from 38 o C to 40 o C. White blood cell count increased from 67.83*10 9 /L (neutrophils being 64.5*10 9 /L) to 72.17*10 9 /L (neutrophils being 70.27*10 9 /L). The patient was considered to have leukemoid reaction complicated with bladder cancer. The patient refused to have bone marrow biopsy, palliative care was provided instead. The patient passed away on 28th Oct 2022. Conclusion: Bladder cancer patients complicated with leukemoid reactions are rarely reported clinically. Even after surgical resection, the outcome was poor. Monitoring of G-CSF level in blood can help to make predictions of the patient’s health condition. Blocking the G-CSF signaling pathway might work as a future therapeutic target for bladder cancer complicated with leukemia reaction.