Bladder cancer in patients with ureteral anomalies presents unique surgical challenges, particularly regarding urinary diversion. This case highlights a novel approach to uretero-ileal anastomosis in a patient with duplicated right ureters undergoing radical cystectomy.
Case Presentation
A 65-year-old man with cT2N0M0 bladder cancer underwent transurethral resection of the bladder tumor, revealing a complete duplex right ureter. Following neoadjuvant chemotherapy, he underwent robot-assisted radical cystectomy with intracorporeal ileal conduit construction. The left ureter was anastomosed using the Bricker technique. To optimize right ureteral drainage, slits were made in both ureters, and their medial margins were sutured to form a Wallace plate, which was subsequently anastomosed to the ileal conduit. Ureteral stents were removed successfully after 2 weeks.
Conclusion
One year postoperatively, no urinary diversion-related complications occurred. The uretero-ileal anastomotic technique should be selected based on the case and the surgeon's or institution's experience.
{"title":"Bricker Technique of Uretero-Ileal Anastomosis for Duplex Ureters Undergoing Intracorporeal Ileal Conduit Construction","authors":"Kyotaro Fukuta, Ryoichi Nakanishi, Keito Shiozaki, Seiya Utsunomiya, Yutaro Sasaki, Takeshi Nakashima, Tomoya Fukawa, Hirofumi Izaki, Junya Furukawa","doi":"10.1002/iju5.70065","DOIUrl":"https://doi.org/10.1002/iju5.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bladder cancer in patients with ureteral anomalies presents unique surgical challenges, particularly regarding urinary diversion. This case highlights a novel approach to uretero-ileal anastomosis in a patient with duplicated right ureters undergoing radical cystectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 65-year-old man with cT2N0M0 bladder cancer underwent transurethral resection of the bladder tumor, revealing a complete duplex right ureter. Following neoadjuvant chemotherapy, he underwent robot-assisted radical cystectomy with intracorporeal ileal conduit construction. The left ureter was anastomosed using the Bricker technique. To optimize right ureteral drainage, slits were made in both ureters, and their medial margins were sutured to form a Wallace plate, which was subsequently anastomosed to the ileal conduit. Ureteral stents were removed successfully after 2 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>One year postoperatively, no urinary diversion-related complications occurred. The uretero-ileal anastomotic technique should be selected based on the case and the surgeon's or institution's experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 5","pages":"462-465"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The association between the risk of latent tuberculosis infection (LTBI) reactivation and immune checkpoint inhibitor (ICI) administration has been reported.
Case Presentation
A man in his seventies underwent robot-assisted laparoscopic radical cystectomy with ileal conduit diversion for muscle-invasive bladder cancer. Three years postoperatively, CT revealed metastases to the para-aortic lymph nodes and rectum. Four cycles of gemcitabine and carboplatin were administered, with CT showing a partial response (PR). Avelumab maintenance therapy was initiated following radiotherapy for the rectal metastasis. Prior to avelumab administration, LTBI was diagnosed based on a positive interferon-gamma release assay (IGRA). Isoniazid was administered concurrently with avelumab for 6 months. No active tuberculosis developed, and PR was maintained.
Conclusion
IGRA screening is advisable prior to ICI initiation. Prompt and appropriate management is warranted in patients with LTBI.
{"title":"A Case of Advanced Urothelial Carcinoma Requiring Treatment Following a Positive Interferon-Gamma Release Assay Prior to Avelumab Administration","authors":"Yukiya Odagiri, Yoshiki Hiyama, Umi Ishida, Naotaka Nishiyama, Yoshihiro Yamamoto, Hiroshi Kitamura","doi":"10.1002/iju5.70063","DOIUrl":"https://doi.org/10.1002/iju5.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The association between the risk of latent tuberculosis infection (LTBI) reactivation and immune checkpoint inhibitor (ICI) administration has been reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A man in his seventies underwent robot-assisted laparoscopic radical cystectomy with ileal conduit diversion for muscle-invasive bladder cancer. Three years postoperatively, CT revealed metastases to the para-aortic lymph nodes and rectum. Four cycles of gemcitabine and carboplatin were administered, with CT showing a partial response (PR). Avelumab maintenance therapy was initiated following radiotherapy for the rectal metastasis. Prior to avelumab administration, LTBI was diagnosed based on a positive interferon-gamma release assay (IGRA). Isoniazid was administered concurrently with avelumab for 6 months. No active tuberculosis developed, and PR was maintained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>IGRA screening is advisable prior to ICI initiation. Prompt and appropriate management is warranted in patients with LTBI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 5","pages":"454-457"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yoshiyuki Miyaji, Shinjiro Shimizu, Michihiro Sato
Introduction
Androgen receptor signaling inhibitors (ARSIs) improve survival in prostate cancer; however, it may increase cardiovascular risks, especially in elderly patients with heart disease.
Case Presentation
A 94-year-old man with aortic valve stenosis, hypertension, and diabetes had a nodal metastatic progression of prostate cancer at 88 years of age, leading to the implementation of androgen deprivation therapy (ADT). After 5 years of therapy, prostate-specific antigen (PSA) re-elevated; however, ADT was maintained. At 94 years old, darolutamide was started due to worsening of urinary symptoms. Although these symptoms improved, the patient developed a heart failure with elevated B-type natriuretic peptide (BNP). Darolutamide was discontinued, leading to reduced BNP levels but increased PSA levels. A reduced dose (300 mg/day) resulted in stable PSA levels without BNP elevation.
Conclusion
Careful cardiovascular monitoring is crucial when ARSIs are used in older patients with heart disease. Dose adjustments may help balance oncological benefits and cardiac safety.
{"title":"Heart Failure Induced by Darolutamide in an Older Patient With M0 Castration-Resistant Prostate Cancer: A Case Report","authors":"Yoshiyuki Miyaji, Shinjiro Shimizu, Michihiro Sato","doi":"10.1002/iju5.70068","DOIUrl":"https://doi.org/10.1002/iju5.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Androgen receptor signaling inhibitors (ARSIs) improve survival in prostate cancer; however, it may increase cardiovascular risks, especially in elderly patients with heart disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 94-year-old man with aortic valve stenosis, hypertension, and diabetes had a nodal metastatic progression of prostate cancer at 88 years of age, leading to the implementation of androgen deprivation therapy (ADT). After 5 years of therapy, prostate-specific antigen (PSA) re-elevated; however, ADT was maintained. At 94 years old, darolutamide was started due to worsening of urinary symptoms. Although these symptoms improved, the patient developed a heart failure with elevated B-type natriuretic peptide (BNP). Darolutamide was discontinued, leading to reduced BNP levels but increased PSA levels. A reduced dose (300 mg/day) resulted in stable PSA levels without BNP elevation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Careful cardiovascular monitoring is crucial when ARSIs are used in older patients with heart disease. Dose adjustments may help balance oncological benefits and cardiac safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 5","pages":"466-469"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of pembrolizumab in patients with microsatellite instability-high (MSI-high) and tumor mutation burden-high (TMB-high) prostate cancer in Japan is not widely reported. Here, we report the case of a patient with MSI-high and TMB-high prostate cancer who responded well to pembrolizumab after multiple systemic treatments.
Case Presentation
A 68-year-old Japanese man was diagnosed with cT4N1M1a prostate cancer. He was treated with several androgen receptor signaling inhibitors and chemotherapy. After intense systemic treatment, disease progression was confirmed, and genomic testing detected MSI-high and TMB-high. However, treatment with pembrolizumab resulted in marked prostate-specific antigen reduction and significant shrinkage of metastases.
Conclusion
Genomic tests should be considered for high-grade tumors. MSI-high and TMB-high prostate cancer responded well to pembrolizumab in this case, but patients should be carefully monitored for the development of side effects after administration of pembrolizumab.
{"title":"TMB-High, MSI-High Castration-Resistant Prostate Cancer Treated With Pembrolizumab","authors":"Satoshi Muraoka, Hisanobu Tosuji, Yuya Iwahashi, Hiroki Kawabata, Ryusuke Deguchi, Takahito Wakamiya, Shimpei Yamashita, Yasuo Kohjimoto, Isao Hara","doi":"10.1002/iju5.70062","DOIUrl":"https://doi.org/10.1002/iju5.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The use of pembrolizumab in patients with microsatellite instability-high (MSI-high) and tumor mutation burden-high (TMB-high) prostate cancer in Japan is not widely reported. Here, we report the case of a patient with MSI-high and TMB-high prostate cancer who responded well to pembrolizumab after multiple systemic treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 68-year-old Japanese man was diagnosed with cT4N1M1a prostate cancer. He was treated with several androgen receptor signaling inhibitors and chemotherapy. After intense systemic treatment, disease progression was confirmed, and genomic testing detected MSI-high and TMB-high. However, treatment with pembrolizumab resulted in marked prostate-specific antigen reduction and significant shrinkage of metastases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Genomic tests should be considered for high-grade tumors. MSI-high and TMB-high prostate cancer responded well to pembrolizumab in this case, but patients should be carefully monitored for the development of side effects after administration of pembrolizumab.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 5","pages":"449-453"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Karasawa, Y. Yasumizu, T. Kosaka, Shimoi, and M. Oya, “Efficacy of trametinib in a metastatic urothelial carcinoma patientwith a BRAF mutation,” IJU Case Reports 7, no. 5 (2024): 375-378, https://doi.org/10.1002/iju5.12759.
In the ‘Case presentation’ section, the first two sentences in the second paragraph read as follows: To provide further treatment for this patient, we conducted cancer multigene panel testing (FoundationOne®). We examined 324 cancer-related genes and identified the BRAF G469A mutations (Fig. 2).
The authors would like to clarify that the cancer panel test was performed at the referring hospital and not at the authors’ hospital. The correct text should be: To provide further treatment for this patient, cancer multigene panel testing (FoundationOne®) was conducted. Analysis of 324 cancer-related genes revealed the BRAF G469A mutation (Fig. 2).
H. Karasawa， Y. Yasumizu， T. Kosaka， Shimoi和M. Oya，“曲美替尼治疗BRAF突变转移性尿路上皮癌的疗效”，《IJU病例报告》第7期。5 (2024): 375-378, https://doi.org/10.1002/iju5.12759.In“病例报告”部分，第二段的前两句如下：为了为该患者提供进一步的治疗，我们进行了癌症多基因面板检测（FoundationOne®）。我们检测了324个癌症相关基因，并确定了BRAF G469A突变（图2）。作者想澄清的是，癌症小组测试是在转诊医院进行的，而不是在作者所在的医院。正确的文字应该是：为了给该患者提供进一步的治疗，我们进行了癌症多基因面板检测（FoundationOne®）。对324个癌症相关基因的分析显示BRAF G469A突变（图2）。
{"title":"Correction to “Efficacy of Trametinib in a Metastatic Urothelial Carcinoma Patient With a BRAF Mutation: A Case Report”","authors":"","doi":"10.1002/iju5.70047","DOIUrl":"https://doi.org/10.1002/iju5.70047","url":null,"abstract":"<p>H. Karasawa, Y. Yasumizu, T. Kosaka, Shimoi, and M. Oya, “Efficacy of trametinib in a metastatic urothelial carcinoma patientwith a BRAF mutation,” <i>IJU Case Reports</i> 7, no. 5 (2024): 375-378, https://doi.org/10.1002/iju5.12759.</p><p>In the ‘Case presentation’ section, the first two sentences in the second paragraph read as follows: To provide further treatment for this patient, we conducted cancer multigene panel testing (FoundationOne®). We examined 324 cancer-related genes and identified the BRAF G469A mutations (Fig. 2).</p><p>The authors would like to clarify that the cancer panel test was performed at the referring hospital and not at the authors’ hospital. The correct text should be: To provide further treatment for this patient, cancer multigene panel testing (FoundationOne®) was conducted. Analysis of 324 cancer-related genes revealed the BRAF G469A mutation (Fig. 2).</p>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a case of renal cell carcinoma with an inferior vena cava tumor thrombus extending into the right atrium and pulmonary embolism, treated using a staged surgical approach.
Case Presentation
A man in his 60s was diagnosed with left clear cell renal cell carcinoma with a tumor thrombus extending to the right atrium, posing a risk of sudden death. Given the high perioperative risk, complete resection in a single session was infeasible. Preoperative administration of a tyrosine kinase inhibitor showed limited effectiveness, and the patient developed pulmonary embolism. An initial thoracotomy was performed to urgently remove the pulmonary artery and right atrial thrombus, along with as much infra-diaphragmatic thrombus as feasible. This was followed by open radical nephrectomy and abdominal inferior vena cava thrombectomy.
Conclusion
The staged approach enabled curative nephrectomy despite the presence of tumor thrombus and pulmonary embolism.
{"title":"Two-Stage Tumor Resection for Locally Advanced Renal Cell Carcinoma With Level IV Tumor Thrombus and Pulmonary Embolism: A Case Report","authors":"Takanari Kambe, Kei Mizuno, Yuki Teramoto, Takayuki Sumiyoshi, Yuki Kita, Kimihiko Masui, Takayuki Goto, Shusuke Akamatsu, Ryoichi Saito, Takashi Kobayashi","doi":"10.1002/iju5.70045","DOIUrl":"https://doi.org/10.1002/iju5.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We report a case of renal cell carcinoma with an inferior vena cava tumor thrombus extending into the right atrium and pulmonary embolism, treated using a staged surgical approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A man in his 60s was diagnosed with left clear cell renal cell carcinoma with a tumor thrombus extending to the right atrium, posing a risk of sudden death. Given the high perioperative risk, complete resection in a single session was infeasible. Preoperative administration of a tyrosine kinase inhibitor showed limited effectiveness, and the patient developed pulmonary embolism. An initial thoracotomy was performed to urgently remove the pulmonary artery and right atrial thrombus, along with as much infra-diaphragmatic thrombus as feasible. This was followed by open radical nephrectomy and abdominal inferior vena cava thrombectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The staged approach enabled curative nephrectomy despite the presence of tumor thrombus and pulmonary embolism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 4","pages":"382-385"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Inoue, A. Niimi, T. Kudo, U. Yoshizaki, Y. Sato, H. Kume
Introduction
Docetaxel is a key treatment for castration-resistant prostate cancer and is administered with prednisolone, which increases the risk of steroid-induced diabetes. Its myelosuppressive effect also increases vulnerability to febrile neutropenia. Metformin is widely used for glycemic control; however, elderly cancer patients are particularly susceptible to metformin-associated lactic acidosis, necessitating careful management of sick-day and febrile neutropenia during chemotherapy.
Case Presentation
We report a 70-year-old male with castration-resistant prostate cancer and diabetes mellitus who developed febrile neutropenia on Day 5 following docetaxel initiation. He progressed to shock with severe metabolic acidosis on Day 7 and died despite intensive care, including continuous renal replacement therapy. A retrospective review revealed continued metformin use despite prodromal fatigue and loss of appetite, likely due to impaired judgment.
Conclusion
This case may have involved septic shock, but metformin likely worsened the lactic acidosis. It highlights the need for sick-day education and monitoring in elderly cancer patients.
{"title":"Metformin-Associated Lactic Acidosis During Docetaxel Therapy for Castration-Resistant Prostate Cancer: A Case Report","authors":"Y. Inoue, A. Niimi, T. Kudo, U. Yoshizaki, Y. Sato, H. Kume","doi":"10.1002/iju5.70055","DOIUrl":"https://doi.org/10.1002/iju5.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Docetaxel is a key treatment for castration-resistant prostate cancer and is administered with prednisolone, which increases the risk of steroid-induced diabetes. Its myelosuppressive effect also increases vulnerability to febrile neutropenia. Metformin is widely used for glycemic control; however, elderly cancer patients are particularly susceptible to metformin-associated lactic acidosis, necessitating careful management of sick-day and febrile neutropenia during chemotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>We report a 70-year-old male with castration-resistant prostate cancer and diabetes mellitus who developed febrile neutropenia on Day 5 following docetaxel initiation. He progressed to shock with severe metabolic acidosis on Day 7 and died despite intensive care, including continuous renal replacement therapy. A retrospective review revealed continued metformin use despite prodromal fatigue and loss of appetite, likely due to impaired judgment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case may have involved septic shock, but metformin likely worsened the lactic acidosis. It highlights the need for sick-day education and monitoring in elderly cancer patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 4","pages":"411-414"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hemophagocytic lymphohistiocytosis (HLH) is characterized by macrophage and cytotoxic lymphocyte hyperactivation, fever, pancytopenia, liver dysfunction, and abnormal coagulation. However, no specific treatments have been established for HLH caused by immune checkpoint inhibitors.
Case Presentation
A 63-year-old male with clear cell renal carcinoma was treated with pembrolizumab and lenvatinib. Fifteen days later, he developed pancytopenia, liver and renal impairments, hypofibrinogenemia, hypertriglyceridemia, and elevated ferritin levels. Subsequently, he was admitted to the ICU for respiratory and circulatory instabilities. The patient was diagnosed with HLH and treated with high-dose corticosteroids and mycophenolate mofetil. Pancytopenia persisted and required massive blood transfusions. Cytomegalovirus infection was found to be the cause, and pancytopenia improved with ganciclovir. The patient was discharged from the ICU after 21 days.
Conclusion
We present the case of a patient who developed HLH as an immune-related adverse event along with a secondary cytomegalovirus infection, resulting in prolonged pancytopenia.
{"title":"A Case of Hemophagocytic Lymphohistiocytosis During Immune Checkpoint Inhibitor Treatment for Metastatic Renal Cell Carcinoma, Complicated by Pancytopenia Attributed to Cytomegalovirus Infection","authors":"Tomoko Honda, Hirohito Naito, Yu Osaki, Yoichiro Tohi, Yuki Matsuoka, Takuma Kato, Homare Okazoe, Rikiya Taoka, Nobufumi Ueda, Mikio Sugimoto","doi":"10.1002/iju5.70058","DOIUrl":"https://doi.org/10.1002/iju5.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hemophagocytic lymphohistiocytosis (HLH) is characterized by macrophage and cytotoxic lymphocyte hyperactivation, fever, pancytopenia, liver dysfunction, and abnormal coagulation. However, no specific treatments have been established for HLH caused by immune checkpoint inhibitors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 63-year-old male with clear cell renal carcinoma was treated with pembrolizumab and lenvatinib. Fifteen days later, he developed pancytopenia, liver and renal impairments, hypofibrinogenemia, hypertriglyceridemia, and elevated ferritin levels. Subsequently, he was admitted to the ICU for respiratory and circulatory instabilities. The patient was diagnosed with HLH and treated with high-dose corticosteroids and mycophenolate mofetil. Pancytopenia persisted and required massive blood transfusions. Cytomegalovirus infection was found to be the cause, and pancytopenia improved with ganciclovir. The patient was discharged from the ICU after 21 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We present the case of a patient who developed HLH as an immune-related adverse event along with a secondary cytomegalovirus infection, resulting in prolonged pancytopenia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 4","pages":"423-426"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spermatogenic dysfunction is a side effect of valganciclovir, which is commonly used to treat cytomegalovirus infections. Here, we report the case of a reproductive man who underwent kidney transplantation and was diagnosed with azoospermia after valganciclovir treatment for cytomegalovirus infection.
Case Presentation
A 30-year-old man underwent an ABO-compatible living-donor kidney transplantation. Two months after the kidney transplant, the patient was diagnosed with cytomegalovirus infection and gastritis. Therefore, valganciclovir treatment was initiated. Two months after completion of valganciclovir treatment, the patient was diagnosed with azoospermia. Azoospermia induced by valganciclovir was suspected, and careful monitoring was performed. Nine months after azoospermia diagnosis, the sperm concentration improved to normal range (43.3 × 106/mL). Subsequently, the patient's wife conceived.
Conclusion
During valganciclovir treatment, careful monitoring and adequate informed consent are needed to support patients of reproductive age.
{"title":"Transient Azoospermia Induced by Valganciclovir Treatment for Cytomegalovirus Infection in a Reproductive Male After Kidney Transplant: A Case Report","authors":"Kosuke Mieda, Shunta Hori, Mitsuru Tomizawa, Kuniaki Inoue, Tatsuo Yoneda, Yuji Nitta, Yasushi Nakai, Makito Miyake, Nobumichi Tanaka, Kiyohide Fujimoto","doi":"10.1002/iju5.70060","DOIUrl":"https://doi.org/10.1002/iju5.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Spermatogenic dysfunction is a side effect of valganciclovir, which is commonly used to treat cytomegalovirus infections. Here, we report the case of a reproductive man who underwent kidney transplantation and was diagnosed with azoospermia after valganciclovir treatment for cytomegalovirus infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 30-year-old man underwent an ABO-compatible living-donor kidney transplantation. Two months after the kidney transplant, the patient was diagnosed with cytomegalovirus infection and gastritis. Therefore, valganciclovir treatment was initiated. Two months after completion of valganciclovir treatment, the patient was diagnosed with azoospermia. Azoospermia induced by valganciclovir was suspected, and careful monitoring was performed. Nine months after azoospermia diagnosis, the sperm concentration improved to normal range (43.3 × 10<sup>6</sup>/mL). Subsequently, the patient's wife conceived.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>During valganciclovir treatment, careful monitoring and adequate informed consent are needed to support patients of reproductive age.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 4","pages":"431-434"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Posterior reversible leukoencephalopathy syndrome (PRES) is a rare but serious complication in kidney transplant recipients, often triggered by calcineurin inhibitors (CNIs) and infections.
Case Presentation
A 52-year-old woman with end-stage kidney disease underwent cadaveric renal transplantation. Two months post-transplant, she presented with headaches, visual disturbances, hypertension, and altered consciousness. Cranial MRI confirmed PRES. After conversion from tacrolimus to cyclosporine and antihypertensive therapy, symptoms improved. However, the patient developed disseminated varicella-zoster virus infection, resulting in meningitis. Treatment with acyclovir and reduction of immunosuppression led to full recovery without recurrence.
Conclusion
This case highlights the importance of recognizing PRES and its triggers, including infections and CNIs, in kidney transplant recipients. Early diagnosis and appropriate management are crucial for preventing severe outcomes.
{"title":"Posterior Reversible Leukoencephalopathy Syndrome and Disseminated Varicella-Zoster Virus Infection After Kidney Transplantation","authors":"Kenji Tsutsui, Shigeaki Nakazawa, Makoto Kinoshita, Yoko Higa, Soichi Matsumura, Shota Fukae, Ryo Tanaka, Norichika Ueda, Yoichi Kakuta, Norio Nonomura","doi":"10.1002/iju5.70030","DOIUrl":"https://doi.org/10.1002/iju5.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Posterior reversible leukoencephalopathy syndrome (PRES) is a rare but serious complication in kidney transplant recipients, often triggered by calcineurin inhibitors (CNIs) and infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 52-year-old woman with end-stage kidney disease underwent cadaveric renal transplantation. Two months post-transplant, she presented with headaches, visual disturbances, hypertension, and altered consciousness. Cranial MRI confirmed PRES. After conversion from tacrolimus to cyclosporine and antihypertensive therapy, symptoms improved. However, the patient developed disseminated varicella-zoster virus infection, resulting in meningitis. Treatment with acyclovir and reduction of immunosuppression led to full recovery without recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case highlights the importance of recognizing PRES and its triggers, including infections and CNIs, in kidney transplant recipients. Early diagnosis and appropriate management are crucial for preventing severe outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 4","pages":"330-333"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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