A 65-year-old man with a history of T1 high-grade bladder cancer with CIS underwent successful transurethral resection of bladder tumor (TURBT), without residual tumor on second resection. Given his pathology, his treatment plan included BCG instillations. The patient tolerated his first bacillus Calmette-Guérin (BCG) instillation well 4 weeks after his second TURBT. After his second BCG instillation, he developed fevers as high as 103 degrees F. He made a visit to the emergency department, where his blood pressure was 80/50 mm Hg and his heart rate was 130 bpm. His lactic acid level was elevated to 4.5. He had a white blood cell count of 2.0, hematocrit of 40, and creatinine level of 1.0.
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