Improvement of urinary symptoms after bladder biopsy: A case of pathologically proven allergy‐related cystitis during administration of nivolumab

Abstract

Introduction We present a case of cystitis, which was considered to be an immune‐related adverse event associated with nivolumab administration. Case presentation A 47‐year‐old man suffered from sudden onset urinary symptoms after 18 cycles of nivolumab treatment for stage IV pulmonary adenocarcinoma. Urine culture and urine cytology were both negative. The symptoms were inferred to be related to nivolumab administration, and a bladder biopsy under spinal anesthesia was performed. The histopathological examination showed the evidence of allergic‐related cystitis. We planned to administer corticosteroids, but the urinary symptoms disappeared after the bladder biopsy. Nivolumab treatment was continued without recurrent bladder symptoms. Conclusion We reported a case of cystitis after treatment with nivolumab, which served as a reminder to consider the possibility of immune‐related adverse events as a potential cause for any symptoms that develop during treatment with immuno‐oncology drugs.

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

“…IrAEs have been suggested to occur at any time but usually develop within the first few weeks to months after administration initiation (19). In previous case reports of ICIrelated cystitis, the time from the initiation of therapy to the development of cystitis ranged from 2 to 12 months (the third to 18th cycles of ICIs) (7)(8)(9)(10)(11)(12)(13)(14)(15). In our report, the patients presented with urinary symptoms that ranged from 3 weeks to 15 weeks The timeline of the treatment course of case 3.…”

“…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).…”

“…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).…”

“…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.…”

Case Report: A Case of Sintilimab-Induced Cystitis/Ureteritis and Review of Sintilimab-Related Adverse Events

“…IrAEs have been suggested to occur at any time, but usually develop within the first few weeks to months after administration initiation ( 8 ). In previous case reports of nivolumab-related cystitis, the time from initiation of therapy to development of cystitis ranged from two to twelve months ( 9 – 11 , 13 ). In a case report of pembrolizumab-induced cystitis, urinary symptoms occurred after six cycles of treatment ( 12 ).…”