A rare retrograde intrarenal surgery complication: Hemophagocytic syndrome

Abstract

Background: Hemophagocytic syndrome (HS) is a syndromic complex that is categorized in the group of histiocytic disorders associated with macrophages. Case Presentation: A 39-year-old male patient was admitted to the outpatient clinic with complaint of left flank pain. A 1 cm kidney stone was found in the upper pole of left kidney at radiologic imaging. The patient underwent retrograde intrarenal surgery (RIRS) with no peroperative complication. High fever and increasing of acute-phase reactants were observed at postoperative first day. Besides resistant fever, pancytopenia developed despite the appropriate antibiotherapy. The urine and blood cultures were sterile. After multidisciplinary consultation, bone marrow sampling was performed. Microscopic examination of the bone marrow material revealed that the macrophage cells phagocyted the erythrocytes, which was compatible with HS. Unfortunately despite the appropriate medical HS treatment, the patient died due to multiorgan failure at the 21st day of RIRS. Conclusion: HS is a significantly rare complication after RIRS, which was presented initially with postoperative fever. HS should be kept in mind if the patient had resistant fever and pancytopenia despite the appropriate antibiotherapy.