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Di C, Yu T, Ni L. Non-bacterial cystitis caused by pembrolizumab therapy for adenocarcinoma of the lung: a case report. Front Immunol 2024; 15:1423123. [PMID: 39034999 PMCID: PMC11257856 DOI: 10.3389/fimmu.2024.1423123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) including anti-programmed death cell protein 1 (anti-PD1) and anti-programmed cell death-ligand 1 (PD-L1), by disinhibiting the antitumor responses of lymphocytes, have extended survival benefits for patients in lung cancer. ICIs can also lead to a wide spectrum of immune-related adverse events (irAEs), due to dysregulation of immune reactions. Here, we report a 27-year-old female patient with adenocarcinoma of the lung treated with pembrolizumab-combined chemotherapy treatment, who complained of urinary irritation symptoms. No bacteria were found in multiple urine cultures. B-mode ultrasonography indicated a high echo in the right lateral wall of the bladder, about 5.6 × 4.5 mm in size. Transurethral bladder tumor resection (TURBT) was operated. At biopsy, we found CD3+ CD8+ lymphocyte, plasma cell, and eosinophil infiltration and lymphoid follicle formation in the bladder mucosal layer. This is a report of non-bacterial inflammation of the urinary tract caused by immunotherapy.
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Affiliation(s)
- Caixia Di
- Department of Pulmonary and Critical Care Medicine, Shanghai Key Discipline for Respiratory Diseases, Institute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, China
| | - Teng Yu
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Ni
- Department of Pulmonary and Critical Care Medicine, Shanghai Key Discipline for Respiratory Diseases, Institute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, China
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Alhusari L, Abdallah M, Nwanwene K, Shenouda M. Acute Non-infectious Cystitis Secondary to Immune-Related Adverse Events in a Patient Receiving Pembrolizumab for Treatment of Non-small Cell Lung Cancer: A Case Report. Cureus 2024; 16:e55666. [PMID: 38586668 PMCID: PMC10997305 DOI: 10.7759/cureus.55666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Immune-related adverse events (IrAEs) involving the bladder are seldom reported and tend to be overlooked by oncologists. Cystitis caused by immune checkpoint inhibitors (ICIs) is rarely reported, with only four documented instances in the literature, of which just one case is attributed to pembrolizumab. We present a rare occurrence of pembrolizumab-induced hemorrhagic cystitis in a 71-year-old male with stage II-b lung adenocarcinoma with an chronic indwelling Foley catheter. He presented with persistent hematuria despite the completion of a course of antibiotics for a urinary infection; a cystoscopic examination was also normal. Drug-induced cystitis was suspected and the patient was treated with prednisone as well as temporary discontinuation of pembrolizumab, which was followed by an improvement of symptoms.
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Affiliation(s)
- Leena Alhusari
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Mahmoud Abdallah
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Kemnasom Nwanwene
- Hematology and Medical Oncology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Mina Shenouda
- Hematology and Medical Oncology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Fan Y, Zhao J, Mi Y, Zhang Z, Geng Y, Zhou L, Shen L, Zhang Z. Recurrent Cystitis Associated With 2 Programmed Death 1 Inhibitors: A Rare Case Report and Literature Review. J Immunother 2023; 46:341-345. [PMID: 37721343 PMCID: PMC10540753 DOI: 10.1097/cji.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced cancer, however, often with immune-related adverse events (irAEs). Adverse events involving the bladder were extremely rare with only few cases. Herein, we described a rare, recurrent cystitis associated with 2 programmed death 1 inhibitors (pembrolizumab and toripalimab) in 1 patient with advanced liver cancer. Cystitis associated with toripalimab, a novel humanized programmed death 1 monoclonal antibody, was first presented in our case. Cystitis is an extremely rare irAE associated with ICIs, especially anti-programmed death 1 antibodies. With widening indications of ICIs in clinical practice, physicians should be also aware of this rare irAE.
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Affiliation(s)
- Yong Fan
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Yue Mi
- Department of Urology, National Urological Cancer Center, Peking University First Hospital, Beijing, China
| | - Zhening Zhang
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Geng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Liqun Zhou
- Department of Urology, National Urological Cancer Center, Peking University First Hospital, Beijing, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
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Zhou Q, Qin Z, Yan P, Wang Q, Qu J, Chen Y. Immune-related adverse events with severe pain and ureteral expansion as the main manifestations: a case report of tislelizumab-induced ureteritis/cystitis and review of the literature. Front Immunol 2023; 14:1226993. [PMID: 37869004 PMCID: PMC10587548 DOI: 10.3389/fimmu.2023.1226993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Immune checkpoint inhibitor (ICI) is an up-to-date therapy for cancer with a promising efficacy, but it may cause unique immune-related adverse events (irAEs). Although irAEs could affect any organ, irAEs-induced whole urinary tract expansion was rarely reported. Herein, we reported a 27-year-old male patient with thymic carcinoma who received the treatment of tislelizumab, paclitaxel albumin and carboplatin. He was hospitalized for severe bellyache and lumbago after 6 courses of treatment. Antibiotic and antispasmodic treatment did not relieve his symptoms. The imaging examinations reported whole urinary tract expansion and cystitis. Therefore, we proposed that the patient's pain was caused by tislelizumab-induced ureteritis/cystitis. After the discontinuation of tislelizumab and the administration of methylprednisolone, his symptoms were markedly alleviated. Herein, we reported a rare case of ICI-induced ureteritis/cystitis in the treatment of thymic cancer and reviewed other cases of immunotherapy-related cystitis and tislelizumab-related adverse events, which will provide a reference for the diagnosis and treatment of ICI-related irAEs.
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Affiliation(s)
| | | | | | | | | | - Yun Chen
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
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LI S, ZHENG K, XU Y, WANG M. [Immune Checkpoint Inhibitors Related Cystoureteritis:
A Case Report and Literature Review]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2023; 26:709-716. [PMID: 37985157 PMCID: PMC10600747 DOI: 10.3779/j.issn.1009-3419.2023.106.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 11/22/2023]
Abstract
A patient with advanced lung adenocarcinoma developed symptoms of frequent urination and urgent urination after 14 cycles of Pembrolizumab combined with chemotherapy. After making comprehensive analysis of the results of urine routine test, renal function, cystoscope and computed tomography (CT) examination, immune checkpoint inhibitors related cystoureteritis and acute kidney injury were considered. The patient's symptoms were relieved after discontinuation of Pembrolizumab combined with chemotherapy. However, the symptoms of urinary irritation worsened significantly after rechallenging Pembrolizumab combined with chemotherapy, and the symptoms was relieved after corticosteroids treatment. If patients develop urinary symptoms during immune checkpoint inhibitors treatment, immune checkpoint inhibitors related cystoureteritis should be considered for early differential diagnosis in order to implement appropriate treatment.
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Anraku T, Hashidate H, Imai T, Kawakami Y. Successful treatment of immune‐related cystitis with bladder hydrodistension. IJU Case Rep 2023. [DOI: 10.1002/iju5.12588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Tsutomu Anraku
- Department of Urology Niigata City General Hospital Niigata Japan
| | - Hideki Hashidate
- Department of Pathology Niigata City General Hospital Niigata Japan
| | - Tomoyuki Imai
- Department of Urology Niigata City General Hospital Niigata Japan
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Li J, Yu YF, Qi XW, Du Y, Li CQ. Immune-related ureteritis and cystitis induced by immune checkpoint inhibitors: Case report and literature review. Front Immunol 2023; 13:1051577. [PMID: 36685488 PMCID: PMC9853439 DOI: 10.3389/fimmu.2022.1051577] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs), including anti-cytotoxic T lymphocyte-associated protein 4 (anti-CTLA4) and anti-programmed death cell protein 1 (anti-PD-1), are increasingly prescribed in metastatic carcinoma therapy. ICI-related kidney injury is gradually recognized by clinicians. However, immune-related ureteritis and cystitis easily go undiagnosed. We report three cases of PD-1 monoclonal antibody (mAb)-related ureteritis and cystitis. We further carried out a review of the literature about ICI-related ureteritis and cystitis. The cases in our reports manifest urinary irritation, sterile pyuria, gross hematuria, hydronephrosis, dilation of the ureters, and acute kidney injury. Urinary irritation improved effectively; urinalysis and renal function returned to normal after glucocorticoid therapy. During ICI therapy, urinalysis and renal function and urinary imaging examination are recommended to be monitored regularly. It contributes to identify immune-related ureteritis/cystitis earlier to efficiently alleviate urinary symptoms and immunologic urinary tract injury through glucocorticoid therapy while avoiding the abuse of antibiotics.
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Affiliation(s)
- Jun Li
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China,Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China,*Correspondence: Jun Li,
| | - Ya-Fen Yu
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Xiao-Wei Qi
- Department of Pathology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Yuan Du
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Chun-Qing Li
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Obayashi A, Hamada-Nishimoto M, Fujimoto Y, Yoshimoto Y, Takahara S. Non-bacterial Cystitis With Increased Expression of Programmed Cell Death Ligand 1 in the Urothelium: An Unusual Immune-Related Adverse Event After Atezolizumab Administration for Metastatic Breast Cancer. Cureus 2022; 14:e25486. [PMID: 35800819 PMCID: PMC9246443 DOI: 10.7759/cureus.25486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/05/2022] Open
Abstract
We report a case of non-bacterial cystitis that occurred after administration of atezolizumab, an antibody against programmed cell death ligand 1 (PD-L1). This cystitis was considered an immune-related adverse event (irAE). A 67-year-old woman with advanced breast cancer (cT4bN1M1, cStage IV) was treated with atezolizumab and nanoparticle albumin-bound (nab) paclitaxel. She consulted a physician for urethral pain and frequent urination during the fourth cycle of treatment. Cystitis symptoms were not relieved by antibiotic treatment and worsened. The results of her urine culture and cytology were negative for malignancy. Cystoscopy showed diffuse redness of the bladder mucosa. A bladder biopsy revealed no evidence of malignancy. Since the patient's symptoms resolved with steroid therapy, urethral pain and frequent urination associated with atezolizumab were considered to be irAE by the diagnosis of exclusion. After immunostaining of the bladder biopsy sections, high PD-L1 expression was detected in the urothelium, which could explain the cause of irAE.
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Affiliation(s)
- Aiko Obayashi
- Department of Breast Surgery, Osaka Saiseikai Noe Hospital, Osaka, JPN
| | | | - Yuri Fujimoto
- Department of Breast Surgery, Breast Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, JPN
| | - Yukiko Yoshimoto
- Department of Breast Surgery, Breast Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, JPN
| | - Sachiko Takahara
- Department of Breast Surgery, Breast Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, JPN
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