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Review
. 2023 Jan 6:13:1051577.
doi: 10.3389/fimmu.2022.1051577. eCollection 2022.

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

Jun Li  1   2 , Ya-Fen Yu  1 , Xiao-Wei Qi  3 , Yuan Du  1 , Chun-Qing Li  1
Affiliations
Review

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

Jun Li et al. Front Immunol. .

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.

Keywords: case report; glucocorticiods; immune checkpoint inhibitors; immune-related adverse; literature review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The HE and immunohistochemistry staining of bladder tissue in case 1. (A) showed effacement of the bladder urothelium (orange arrow), hyperplastic granulation tissue (blue arrow). (B) showed infiltration of monocytes, lymphocytes, plasmacytes (blue arrow), and neutrophils in the bladder tissue (orange arrow). (C) showed infiltration of CD3-positive lymphocytes in the bladder tissue (positive staining is brown). (D) showed positive infiltration of CD20-positive lymphocytes in the bladder tissue (positive staining is brown). (E) showed positive infiltration of CD117-positive mast cells in the bladder tissue (positive staining is brown). (F) showed that programmed death ligand-1(PD-L1) staining is negative in the bladder tissue. HE, hematoxylin-eosin.
Figure 2
Figure 2
The images of the three cases. (A–C) showed hydronephrosis, dilation of the ureters, and a thickened bladder wall in case 1. (D, E) showed hydronephrosis and dilation of the ureter on the left in case 2. (F, G) showed dilation of the ureters and a thickened ureter wall in case 3.
Figure 3
Figure 3
The timeline of the treatment course of case 1.
Figure 4
Figure 4
The timeline of the treatment course of case 2.
Figure 5
Figure 5
The timeline of the treatment course of case 3.
See this image and copyright information in PMC

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