Anraku Tsutomu, Hashidate Hideki, Imai Tomoyuki, Kawakami Yoshiaki
Department of Urology Niigata City General Hospital Niigata Japan.
Present address: Department of Urology, Molecular Oncology Niigata University Asahimachi-dori 1-757, Chuo-ku Niigata City Niigata 951-8510 Japan.
IJU Case Rep. 2023 Apr 3;6(4):211-215. doi: 10.1002/iju5.12588. eCollection 2023 Jul.
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.
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.
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.
尽管免疫检查点抑制剂为晚期癌症患者带来了显著的治疗益处，但它们也可能引发各种免疫相关的不良事件。随着免疫检查点抑制剂的广泛应用，罕见的免疫相关不良事件也不断被报道。
一名70岁的晚期涎腺导管癌男性患者在放疗后接受派姆单抗治疗。在接受两剂派姆单抗后，患者出现排尿疼痛和血尿等症状。怀疑为免疫相关膀胱炎，患者接受了膀胱活检和膀胱水扩张术。组织学分析显示非肿瘤性膀胱黏膜有以CD8阳性淋巴细胞为主的炎性细胞浸润，符合免疫相关膀胱炎。患者术后膀胱症状改善，未使用类固醇药物。
尽管通常使用类固醇来治疗免疫相关不良事件，但膀胱水扩张术可能是免疫相关膀胱炎的一种有前景的治疗选择，可避免使用可能损害免疫检查点抑制剂治疗效果的类固醇药物。
