A Case Report of Non-Bacterial Cystitis Caused by Immune Checkpoint Inhibitors

Zhu, Sihui; Bian, Lijuan; Lv, Jia; Liu, Baorui; Shen, Jie

doi:10.3389/fimmu.2021.788629

Cited by 9 publications

(11 citation statements)

References 21 publications

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“…Four cases of cystitis have been associated with nivolumab [ 4 - 6 ], one case with pembrolizumab [ 7 ], and one case with sintilimab [ 8 ]. In one case, combined therapy of nivolumab and ipilimumab was used [ 9 ]; in one case, cystitis occurred during nivolumab therapy and recurred during atezolizumab therapy [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…The immune-related adverse events (irAEs) of checkpoint inhibitors differ from those of conventional chemotherapy [ 1 ]. Although various events can occur throughout the body, irAEs affecting the bladder and urinary tract are rare; to date, there is only one case of cystitis associated with atezolizumab therapy [ 2 ]. Herein, we report a rare case of cystitis that developed after administration of atezolizumab, an antibody against programmed cell death ligand 1 (PD-L1), in a patient with breast cancer.…”

Section: Introductionmentioning

confidence: 99%

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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

Ôbayashi¹,

Hamada-Nishimoto²,

Fujimoto³

et al. 2022

Cureus

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ôbayashi¹,

Hamada-Nishimoto²,

Fujimoto³

et al. 2022

Cureus

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“…We further performed a review of the literature about ICIrelated ureteritis and cystitis (7)(8)(9)(10)(11)(12)(13)(14)(15). Eight papers were retrieved to be about ICI-related cystitis and one paper about ICIrelated ureteritis/cystitis (10).…”

Section: Discussionmentioning

confidence: 99%

“…Ten cases were reported to have 11 episodes of urinary irritation after ICI therapy. Of the 10 cases, acute kidney injury was complicated in one case, and immune-related cystitis reoccurred in one case after PD-1 mAb restarting (7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

“…The ICIs, which could induce immune-related cystitis, were mainly PD-1/PD-L1 blockers (n = 10), including nivolumab (PD-1 mAb, n = 7) (7,8,11,12,14,15), pembrolizumab (PD-1 mAb, n = 1) (13), sintilimab (PD-1 mAb, n = 1) (10), and atezolizumab (PD-L1 mAb, n = 2) (9,15). The three cases in our report were also diagnosed as PD-1 mAb-related ureteritis and cystitis.…”

Section: Discussionmentioning

confidence: 99%

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Immune-related ureteritis and cystitis induced by immune checkpoint inhibitors: Case report and literature review

Yu²,

Qi³

et al. 2023

Front. Immunol.

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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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Successful treatment of immune‐related cystitis with bladder hydrodistension

et al. 2023

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Introduction: Although immune checkpoint inhibitors offer significant therapeutic benefits to patients with advanced cancer, they can also cause a variety of immunerelated adverse events. As immune checkpoint inhibitors are being widely used, rare immune-related adverse events are being reported. Case presentation: A 70-year-old man with advanced salivary duct carcinoma was treated with pembrolizumab following radiotherapy. After receiving two doses of pembrolizumab, the patient experienced symptoms such as micturition pain and hematuria. Immune-related cystitis was suspected, and the patient underwent a bladder biopsy and bladder hydrodistension. Histological analysis revealed non-neoplastic bladder mucosa with CD8-positive lymphocyte-dominant inflammatory cell infiltration, consistent with immune-related cystitis. The patient's bladder symptoms improved postoperatively without steroid administration. Conclusion: Although steroids are commonly administered to treat immune-related adverse events, bladder hydrodistension may be a promising treatment option for immune-related cystitis to avoid administration of steroids, which may impair the therapeutic effect of immune checkpoint inhibitors.

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A Case Report of Non-Bacterial Cystitis Caused by Immune Checkpoint Inhibitors

Cited by 9 publications

References 21 publications

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

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

Immune-related ureteritis and cystitis induced by immune checkpoint inhibitors: Case report and literature review

Successful treatment of immune‐related cystitis with bladder hydrodistension

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