Granulomatosis with polyangiitis induced by the anti-programmed cell death-1 inhibitor tislelizumab: A case report.

Abstract

Background: Immune checkpoint inhibitors (ICIs) are a new class of antitumor agents. They enhance antitumor effects by blocking inhibitory receptors and related ligands expressed on T cells. ICIs also modulate regular immune cell activity, affecting the immune system and causing immune-related adverse events. The renal system is sometimes affected by these adverse events. Currently, the literature on ICIs-related glomerular injuries is scarce.

Case summary: We present a patient who developed granulomatosis with polyangiitis (GPA) 3 weeks after treatment with the anti-programmed cell death-1 inhibitor, tislelizumab. The patient experienced proteinuria, hematuria, and acute kidney injury without pulmonary hemorrhage and tested positive for anti-neutrophil cytoplasmic antibody (ANCA)-cytoplasmic type. Renal biopsy confirmed ANCA-associated vasculitis, and GPA was finally diagnosed. The patient received pulse treatment with glucocorticoids and cyclophosphamide, and renal function improved. After self-discontinuation of the drug, the disease recurred, and the original treatment regimen was continued. However, the patient's renal function continued to deteriorate.

Conclusion: Glucocorticoids plus cyclophosphamide are effective for treating GPA induced by tislelizumab. However, follow-up and patient education are needed.