Zhao JH, Wang JJ, Li YW. Granulomatosis with polyangiitis induced by the anti-programmed cell death-1 inhibitor tislelizumab: A case report. World J Clin Cases 2025; 13(15): 103239 [DOI: 10.12998/wjcc.v13.i15.103239]
Corresponding Author of This Article
Jian-Hui Zhao, MD, Associate Chief Physician, Department of Nephrology, Xinchang County People's Hospital, No. 117 Gushan Middle Road, Nanming Street, Xinchang County, Shaoxing 312500, Zhejiang Province, China. lyzhaojh@126.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 26, 2025; 13(15): 103239 Published online May 26, 2025. doi: 10.12998/wjcc.v13.i15.103239
Granulomatosis with polyangiitis induced by the anti-programmed cell death-1 inhibitor tislelizumab: A case report
Jian-Hui Zhao, Jing-Jiao Wang, Yi-Wen Li
Jian-Hui Zhao, Department of Nephrology, Xinchang County People's Hospital, Xinchang 312500, Zhejiang Province, China
Jing-Jiao Wang, Department of Medical Oncology, Xinchang County People's Hospital, Shaoxing 312500, Zhejiang Province, China
Yi-Wen Li, Department of Nephrology, Urology and Nephrology Center, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
Author contributions: Zhao JH contributed to manuscript writing and editing, and data collection; Wang JJ contributed to data analysis; Li YW contributed to conceptualization and provided supervision; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this anonymized report and any accompanying images.
Conflict-of-interest statement: The authors declare having no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist statement, and the manuscript was prepared and revised according to the CARE Checklist statement.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Hui Zhao, MD, Associate Chief Physician, Department of Nephrology, Xinchang County People's Hospital, No. 117 Gushan Middle Road, Nanming Street, Xinchang County, Shaoxing 312500, Zhejiang Province, China. lyzhaojh@126.com
Received: November 13, 2024 Revised: December 19, 2024 Accepted: January 9, 2025 Published online: May 26, 2025 Processing time: 69 Days and 20.3 Hours
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.
Core Tip: Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) due to immune checkpoint inhibitors is extremely rare. AAV caused by the programmed cell death-1 inhibitor, tislelizumab, has not been reported. Our patient developed AAV and granulomatosis with polyangiitis after tislelizumab treatment. Glucocorticoids given in combination with cyclophosphamide effectively treated our patient. However, after the patient discontinued treatment without authorization, the vasculitis recurred. The glucocorticoid + cyclophosphamide regimen was continued, but the patient’s renal function deteriorated.
