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

Lingfang Tu; Yuan Ye; Xiaoping Tang; Zhen Liang; Qihan You; Jianying Zhou; Zhijie Pan

doi:10.3389/fonc.2021.757069

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

Front Oncol. 2021 Dec 23:11:757069. doi: 10.3389/fonc.2021.757069. eCollection 2021.

Authors

Lingfang Tu¹, Yuan Ye¹, Xiaoping Tang¹, Zhen Liang², Qihan You³, Jianying Zhou¹, Zhijie Pan¹

Affiliations

¹ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
² Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
³ Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Abstract

Immune checkpoint inhibitors (ICIs) have been proven to be beneficial in multiple advanced malignancies. However, the widespread use of ICIs also occurred with various immune-related adverse events (irAEs). Here, we first report a case of sintilimab-related cystitis/ureteritis. A 53-year-old man with driver gene-negative pulmonary adenocarcinoma (cT_1cN₃M_1c, Stage IVB) was being treated with sintilimab in combination of paclitaxel-albumin and bevacizumab as second-line treatment. He was hospitalized for haematuria, pollakiuria, painful micturition and low back pain after three courses. Urinalysis showed red blood cells (RBCs) and white blood cells (WBCs) were obviously increased, and serum creatinine (sCr) level was also significantly elevated. Urine culture and cytology were both negative, and cystoscopy revealed diffused redness of bladder mucosa. Urinary ultrasonography showed mild hydronephrosis and dilated ureter. The patient was diagnosed as immunotherapy-related cystitis/ureteritis after a multidisciplinary team (MDT) meeting. Once the diagnosis was made, corticosteroid therapy was given, which rapidly resolved the patient's symptoms and signs. Computer tomography angiography (CTA) and CT urography (CTU) was conducted after sCr level was back to normal and demonstrated ureter dilation and hydroureter. Once symptoms relieved, bladder biopsy was performed and confirmed the bladder inflammation. The patient was subsequently switched to maintenance dose of methylprednisolone and tapered gradually. Since sintilimab has been used in advanced malignancies, we first reported a rare case of sintilimab-induced cystitis/ureteritis and summarized sintilimab-related adverse events to improve the assessment and management of irAEs.

Keywords: cystitis; immune checkpoint inhibitor; immune-related adverse events; sintilimab; ureteritis.

Publication types

Case Reports