To report a case of non-bacterial cystitis and acute kidney injury in a 59-year-old male patient with alpha-fetoprotein-producing gastric carcinoma following treatment with toripalimab and SOX chemotherapy.
Approach:
Case Presentation: A 59-year-old male with AFP-GC developed urinary symptoms and AKI after neoadjuvant therapy with toripalimab and SOX chemotherapy.
Diagnosis: Cystoscopy and biopsy confirmed non-bacterial cystitis with extensive lymphocyte infiltration and high PD-L1 expression.
Treatment: The patient was treated with a full-dose methylprednisolone pulse, which alleviated symptoms and restored renal function.
Key Findings:
The patient developed urinary tract irritation, gross hematuria, and stage II AKI after immunotherapy.
Cystoscopy revealed diffuse mucosal hemorrhage, and a biopsy showed extensive lymphocyte infiltration.
Full-dose corticosteroids effectively managed the symptoms and improved renal function.
Interpretation:
This case highlights the potential for immune-related adverse events affecting the urinary system in patients receiving ICIs, particularly in the context of AFP-GC.
Limitations:
The case study is based on a single patient, limiting generalizability.
There is a lack of consensus on the diagnosis and management of non-bacterial cystitis as an irAE.
Conclusion:
Early identification and management of urinary system irAEs are critical in patients undergoing immunotherapy, particularly in rare cancer subtypes like AFP-GC.
