IJU Case Reports最新文献

{"title":"Could Ovarian Veins Be the Origin of Most Retroperitoneal Leiomyosarcomas?","authors":"Cuneyt Kayaalp","doi":"10.1002/iju5.70067","DOIUrl":"https://doi.org/10.1002/iju5.70067","url":null,"abstract":"<p>I have read with interest the case report of Iwagami et al. “Internal High Echoes Can Suggest the Possible Resection of Ovarian Vein Leiomyosarcoma: A Case Report” [<span>1</span>], which describes a rare patient with leiomyosarcoma originating from the right gonadal vein. The authors have clearly defined the radiological continuity of the tumor with the gonadal vein and revealed its relationship with adjacent structures such as the vena cava and duodenum.</p><p>The authors have successfully revealed that the gonadal vein is the source of a retroperitoneal leiomyosarcoma, I congratulate them. The origin of the majority of retroperitoneal leiomyosarcomas cannot be determined. But there are some indirect findings that suggest that a significant part of it may actually be originated from gonadal veins.</p><p>Awareness is needed for future studies to evaluate gonadal veins as a potential source of retroperitoneal leiomyosarcomas of uncertain origin. For this reason, I believe that retroperitoneal leiomyosarcomas, whose origin has been definitively established, although rare, are important, as in this case.</p><p>The fact that the gonadal vein has a possible origin in retroperitoneal leiomyosarcomas could potentially change treatment strategies. Immunohistochemical profile examinations in pathological examinations can be a guide in this regard.</p><p>The author declares no conflicts of interest.</p><p>This article is linked to Iwagami et al. paper. To view this article, visit https://doi.org/10.1002/iju5.70025.</p>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 5","pages":"546-547"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935430","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}

{"title":"Whether the Opsoclonus Myoclonus Syndrome Is Paraneoplastic or SARS-CoV-2–Related Can Be Clarified","authors":"Josef Finsterer","doi":"10.1002/iju5.70066","DOIUrl":"https://doi.org/10.1002/iju5.70066","url":null,"abstract":"&lt;p&gt;We read with interest the article by Tomomasa et al. about a 76-year-old man with metastatic prostate cancer, concurrent SARS-CoV-2 infection (SC2I) and opsoclonus-myoclonus syndrome (OMS) attributed to SC2I or interpreted as paraneoplastic syndrome (PNS) [&lt;span&gt;1&lt;/span&gt;]. The patient benefited from orchidectomy, endocrine therapy (degarelix, bicalutamide) and glucocorticoids and partially recovered [&lt;span&gt;1&lt;/span&gt;]. The study is remarkable, but several points need to be discussed.&lt;/p&gt;&lt;p&gt;The first point is that the diagnosis of SC2I was made on the basis of suspicion and not evidence [&lt;span&gt;1&lt;/span&gt;]. There is no mention of whether a nasopharyngeal swab was positive for SARS-CoV-2 on PCR or not; a positive PCR test is mandatory for the diagnosis of SC2I. It is also not mentioned what kind of treatment against SC2I the patient has received.&lt;/p&gt;&lt;p&gt;The second point is that the diagnosis of OMS is not confirmed [&lt;span&gt;1&lt;/span&gt;]. It was reported that the patient had “right horizontal nystagmus,” but this does not meet the definition of opsoclonus. Opsoclonus is defined as rapid, involuntary, and chaotic eye movements that are conjugate and multidirectional in horizontal, vertical, and torsional planes, are arrhythmic, and have no regular pattern or intersaccadic interval (no pause between eye movements) [&lt;span&gt;2&lt;/span&gt;]. In addition to opsoclonus, OMS is characterized by myoclonus, which did not occur in the index patient [&lt;span&gt;1&lt;/span&gt;]. Myoclonus is defined as sudden, involuntary, and brief muscle twitching or jerking due to either sudden muscle contractions (positive myoclonus) or sudden muscle relaxation (negative myoclonus) [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The third point is that it was not stated whether the MRI of the brain and spinal cord was performed with or without contrast [&lt;span&gt;1&lt;/span&gt;]. To exclude autoimmune encephalitis (AIE) or immune myelitis as a complication of SC2I or as a manifestation of PNS, contrast administration would have been mandatory.&lt;/p&gt;&lt;p&gt;The fourth point is that it was not reported whether CSF examinations were performed or not [&lt;span&gt;1&lt;/span&gt;]. To possibly differentiate between OMS as a complication of SC2I or as a manifestation of PNS, it would have been useful to examine the CSF for pleocytosis, abnormal proteins, immune parameters, and for antibodies related to AIE, immune myelitis, or PNS [&lt;span&gt;1&lt;/span&gt;]. Antibodies associated with AIE or myelitis include NMDA, AMPA, LGI1, CASPR2, GABA-A, GABA-B, DPPX, glycine, neurexin, MIG, or IgLON [&lt;span&gt;4&lt;/span&gt;]. Antibodies associated with PNS include anti-Hu (ANNA1), anti-Yo (PCCA), anti-Ri (ANNA2), Ma1, Ma2, CRMP5 (CV2), amphiphysin, Tr, Zic4, ANNa3, PCA2, AGNA, VGCC, VGKC, mGluR1, and NDMAR antibodies [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The fifth point is that the patient presented with rotary vertigo but was still diagnosed with peripheral vertigo [&lt;span&gt;1&lt;/span&gt;]. Rotational vertigo is usually associated with a central nervous system cause of vertigo. There was also no mention of whe","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"8 5","pages":"544-545"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/iju5.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935502","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}

{"title":"Bricker Technique of Uretero-Ileal Anastomosis for Duplex Ureters Undergoing Intracorporeal Ileal Conduit Construction","authors":"Kyotaro Fukuta,&nbsp;Ryoichi Nakanishi,&nbsp;Keito Shiozaki,&nbsp;Seiya Utsunomiya,&nbsp;Yutaro Sasaki,&nbsp;Takeshi Nakashima,&nbsp;Tomoya Fukawa,&nbsp;Hirofumi Izaki,&nbsp;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}

{"title":"A Case of Advanced Urothelial Carcinoma Requiring Treatment Following a Positive Interferon-Gamma Release Assay Prior to Avelumab Administration","authors":"Yukiya Odagiri,&nbsp;Yoshiki Hiyama,&nbsp;Umi Ishida,&nbsp;Naotaka Nishiyama,&nbsp;Yoshihiro Yamamoto,&nbsp;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}

{"title":"Heart Failure Induced by Darolutamide in an Older Patient With M0 Castration-Resistant Prostate Cancer: A Case Report","authors":"Yoshiyuki Miyaji,&nbsp;Shinjiro Shimizu,&nbsp;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}

{"title":"TMB-High, MSI-High Castration-Resistant Prostate Cancer Treated With Pembrolizumab","authors":"Satoshi Muraoka,&nbsp;Hisanobu Tosuji,&nbsp;Yuya Iwahashi,&nbsp;Hiroki Kawabata,&nbsp;Ryusuke Deguchi,&nbsp;Takahito Wakamiya,&nbsp;Shimpei Yamashita,&nbsp;Yasuo Kohjimoto,&nbsp;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}

{"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}

{"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,&nbsp;Kei Mizuno,&nbsp;Yuki Teramoto,&nbsp;Takayuki Sumiyoshi,&nbsp;Yuki Kita,&nbsp;Kimihiko Masui,&nbsp;Takayuki Goto,&nbsp;Shusuke Akamatsu,&nbsp;Ryoichi Saito,&nbsp;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}

{"title":"Metformin-Associated Lactic Acidosis During Docetaxel Therapy for Castration-Resistant Prostate Cancer: A Case Report","authors":"Y. Inoue,&nbsp;A. Niimi,&nbsp;T. Kudo,&nbsp;U. Yoshizaki,&nbsp;Y. Sato,&nbsp;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}

{"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,&nbsp;Hirohito Naito,&nbsp;Yu Osaki,&nbsp;Yoichiro Tohi,&nbsp;Yuki Matsuoka,&nbsp;Takuma Kato,&nbsp;Homare Okazoe,&nbsp;Rikiya Taoka,&nbsp;Nobufumi Ueda,&nbsp;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}