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Case Reports
. 2023 Apr 3;6(4):211-215.
doi: 10.1002/iju5.12588. eCollection 2023 Jul.

Successful treatment of immune-related cystitis with bladder hydrodistension

Tsutomu Anraku  1   2 , Hideki Hashidate  3 , Tomoyuki Imai  1 , Yoshiaki Kawakami  1
Affiliations
Case Reports

Successful treatment of immune-related cystitis with bladder hydrodistension

Tsutomu Anraku et al. IJU Case Rep. .

Abstract

Introduction: Although immune checkpoint inhibitors offer significant therapeutic benefits to patients with advanced cancer, they can also cause a variety of immune-related 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.

Keywords: hydrodistension; immune checkpoint inhibitor; immune‐related cystitis; interstitial cystitis; steroid.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Pelvic imaging with contrast‐enhanced CT. The bladder wall is thickened with contrast enhancement of the mucosa (arrowhead).
Fig. 2
Fig. 2
Hematoxylin and eosin staining of the bladder tissue. Non‐neoplastic bladder mucosa with epithelial detachment, interstitial edema, vascular hyperplasia, and inflammatory cell infiltration is observed in a hematoxylin–eosin‐stained specimen of the bladder. Scale bar indicates 200 μm.
Fig. 3
Fig. 3
Immunohistochemical results in the bladder tissue. (a) CD3; (b) CD4; (c) CD8; (d) CD20. Scale bar indicates 200 μm.
See this image and copyright information in PMC

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